- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01769287
EP Study of Patients Who Have Received Left Atrial Ablation Using High Intensity Focused Ultrasound (AfMAZE EP)
EP Study at >1 Year to Evaluate the Presence of Conduction Block Across the Cinch Line in Patients Who Have Received Left Atrial Ablation Using High Intensity Focused Ultrasound(HIFU)
The purpose of this study is to check if at 1 year after surgical ablation the electrical impulses that cause atrial fibrillation (AF) are still blocked from being able to get into the heart.
Hypothesis Conduction block and ganglionic destruction are required for freedom from AF.
Study Overview
Status
Conditions
Detailed Description
Atrial fibrillation (AF) is an increasing common disease. It ranges from being asymptomatic to a highly disabling condition with a severe impact on quality of life. It is termed paroxysmal (PAF) when an episode lasts less than 7 days, persistent (PerAF) when it lasts more than 7 days and needs intervention and permanent (PermAF) when it is accepted as the long term rhythm. Treatment is based on symptom control and the prevention of complications such as stroke. When an attempt is made to restore normal sinus rhythm (NSR), this is termed 'rhythm control'.
Treatments for rhythm control of AF can be broadly divided into pharmacological and ablative. Ablative techniques1 are typically performed percutaneously using catheter-based technology (minimally invasive), though some surgical techniques also exist. They work on the principle that performing a series of 'burns' (scar) in appropriate places can prevent abnormal electrical signals forming and propagating within the heart.
The problem of atrial fibrillation is vast. Prevalence ranges from 0.2% in the 45-54 age group, rising to 8% in the over 75s. Though the majority of patients can be satisfactorily treated medically, in a not insignificant portion, the drugs are either poorly tolerated or are ineffective. For these patients, the United Kingdom (UK) NICE guidelines recommend consideration of an ablation procedure. In Derriford hospital alone we see approximately 14 patients suitable for AF ablation in a typical month.
The electrophysiological consequences of ablation are unclear. It is not known whether complete bidirectional electrical block across the ablation lines isolating the pulmonary antral region from the rest of the left atrium is a prerequisite for long-term cure of Atrial Fibrillation (AF). Studies in canine models of atrial fibrillation have suggested that incomplete lines of block can be as effective in reducing AF burden as complete lines, however the limited number of follow up studies in humans that have assessed both patients with recurrent AF and also asymptomatic patients who appear to have been cured by catheter ablation have suggested that complete electrical isolation of the pulmonary veins is necessary for a cure. Advocates for ablation without assessing electrical block argue success rates in humans are similar whether circumferential electrical isolation of the pulmonary veins is achieved or not. Assessing freedom from AF and correlating it with the presence or absence of complete bidirectional electrical block, intra-operatively and at post one-year follow-up, will allow a further understanding of the mechanisms determining the success or failure of AF ablation therapies. This will be very important in knowing how to treat patients in whom AF still occurs and will guide the approach to subsequent interventions.
Though there is a small risk involved in this study, the question it addresses will have a significant impact on the development of future AF ablation techniques. Within this group, over 300 separate ablation procedures have been performed with no deaths or significant complications. Previous groups have published trans-septal observational studies in humans demonstrating that previous ethics committees have appreciated the importance of such work. The 2012 Heart Rhythm Society (HRS)/European Heart Rhythm Association (EHRA)/European Cardiac Arrhythmia Society (ECAS) consensus statement on catheter and surgical ablation for AF has recently highlighted the need for novel trial designs demonstrating 'durability of pulmonary vein isolation' with a repeat diagnostic electrophysiological study.
This trial will therefore increase our understanding of the electrophysiological properties associated with successful ablation and how Atrial Fibrillation ablation and the HIFU procedure work.
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
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Devon
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Plymouth, Devon, United Kingdom, PL6 8BX
- Plymouth Hosptals NHS Trust
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
All patients will be screened prior to enrollment in the study. The following inclusion criteria will apply to all prospective candidates:
- Patients who have undergone an Epicor HIFU ablation >12 months ago
- Patients having the ability to fully comply with the study requirements
- Patients who have given written fully informed consent to participate in the study
Exclusion Criteria:
Patients will be excluded from the study if they meet any of the following criteria:
- Patients who are unable to give full informed consent for the present sub-study.
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
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Surgical operation
The study aims to recruit a total of 20 patients, 10 of whom have AF and 10 who do not.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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To document the incidence of 1 year post ablation bidirectional conduction block through the pulmonary venous cinch and mitral lines
Time Frame: 1 year
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Incidence of conduction block post ablation at 12 months across the pulmonary venous and mitral lines.
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1 year
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Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Malcolm Dalrymple-Hay, MB BS, PhD, University Hospital Plymouth NHS Trust
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- AF08004AF
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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