- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02571218
AF Substrate Mapping and Guided Ablation
Substrate-Targeted Catheter Ablation to Treat Persistent Atrial Fibrillation
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This study is a prospective, single center, randomized, single-blind, controlled, 2-arm parallel group trial in Milan, Italy.
The total duration of the study is expected to be 24 months with ~12 months of enrollment.
Approximately 80 subjects suffering from persistent AF will be randomized in a 1:1 fashion to the following investigation arms:
- Modified circumferential pulmonary vein ablation alone (mCPVA);
Substrate-targeted ablation guided by AF substrate mapping, followed by completion of modified circumferential pulmonary vein ablation (Substrate+ mCPVA)
- Ablate the areas that have fast and regular electrical activities, starting from the fastest cycle length (defined by Mean CL in the range of 120-250 milliseconds, and SD CL in the range of 1-30 milliseconds
- Ablate the areas that have consistent rotational or focal propagation pattern (defined by conduction velocity vectors)
- Ablate the areas that comprises the slow conduction zone of possible arrhythmia circuits
- If AF terminates during RF ablation, stimulation protocol will be used to examine if AF is re-inducible. If AF sustains or is re-inducible and physician decides to remap, mapping will be performed again for substrate-targeted ablation. If AF is not re-inducible, mCPVA will be completed
Subjects will be followed up at 3, 6, 12 months.
The primary objective of the study is to assess acute and long-term outcome of patient-tailored substrate-targeted ablation (Substrate) plus modified circumferential pulmonary vein ablation (Substrate+mCPVA) versus modified circumferential pulmonary vein ablation alone (mCPVA). The secondary objective of the study is to map and characterize electrophysiological substrates during AF, including regular and fast activities, complex fractionated electrograms, wave front propagation directions, and fibrosis.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
MI
-
San Donato Milanese, MI, Italy, 20097
- I.R.C.C.S. Policlinico San Donato
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- 18 - 85 years of age
- Persistent AF scheduled to undergo catheter ablation with approved standard indication by ESC/EHRA guidelines
- First or second time ablation for persistent AF
- Ability to provide written informed consent for study participation and be willing and able to comply with the study evaluations and follow up schedule
Exclusion Criteria:
- Had two or more previous AF ablation procedures
- Secondary AF
- Hyperthyroidism
- Left ventricular ejection fraction <30%
- NYHA functional class IV
- Left atrial area > 35 cm2
- Uncorrected severe valvular heart disease
- Contraindication to anticoagulation
- Presence of left atrial thrombus
- Recent (<6 Months) myocardial Infarction or unstable angina or coronary artery by-pass
- Thoracic surgery for congenital, valvular or aortic disease
- History of cerebrovascular accidents
- Pregnancy
- Significant comorbidities such as cancer, severe renal insufficiency requiring hemodialysis, severe obstructive lung disease, cirrhosis, with a life expectancy less than 2 years
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: SINGLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: mCPVA
Subjects in the mCPVA arm will undergo intervention called "modified circumferential pulmonary vein ablation", which is considered to be the standard ablation treatment for AF.
|
The intervention in the active comparator arm includes using the commercially available EnSite Velocity mapping and ablation system for modified circumferential pulmonary vein ablation.
|
Experimental: Substrate+mCPVA
Subjects in the Substrate+mCPVA arm will undergo intervention of substrate mapping and substrate-targeted ablation guided by the investigational device, followed by completion of modified circumferential pulmonary vein ablation.
|
The intervention in the experimental arm includes using a research software (investigational device) to map AF substrate and guide ablation.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Long-term Clinical Success Rate
Time Frame: 12 months
|
Freedom from symptomatic AF off antiarrhythmic drug therapy assessed from the end of the 3 months blanking period to 12 months following the ablation procedure, documented by implantable loop recorder (ILR) monitoring or trans-telephonic (TT) ECG monitoring.
|
12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Acute Ablation Procedure Outcome
Time Frame: During Ablation
|
Acute AF termination or significant AF cycle length slowing during RF application in ablation procedure
|
During Ablation
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Carlo Pappone, MD, PhD, I.R.C.C.S. Policlinico San Donato
Publications and helpful links
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
- SJM-CIP-10054
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.
Clinical Trials on Persistent Atrial Fibrillation
-
Ablacon, Inc.CompletedArrhythmias, Cardiac | Atrial Fibrillation, Persistent | Persistent Atrial Fibrillation | Longstanding Persistent Atrial FibrillationGermany
-
University of LuebeckIHF GmbH - Institut für HerzinfarktforschungRecruitingPersistent or Long-standing Persistent Atrial FibrillationGermany
-
AtriCure, Inc.Active, not recruitingPersistent Atrial Fibrillation | Atrial Fibrillation (AF) | Longstanding Persistent Atrial FibrillationUnited States
-
St. George's Hospital, LondonRecruitingAtrial Fibrillation | Atrial Fibrillation, Persistent | Persistent Atrial Fibrillation | Atrial ArrhythmiaUnited Kingdom
-
Barts & The London NHS TrustAtriCure, Inc.Not yet recruitingAtrial Fibrillation, Persistent | Persistent Atrial Fibrillation | Atrial Arrhythmia | Atrium; FibrillationUnited Kingdom
-
Xinhua Hospital, Shanghai Jiao Tong University...RecruitingPersistent Atrial Fibrillation | Longstanding Persistent Atrial FibrillationChina
-
University Medical Centre LjubljanaWithdrawnPersistent Atrial Fibrillation | Longstanding Persistent Atrial FibrillationSlovenia
-
AtriCure, Inc.CompletedPersistent Atrial Fibrillation | Longstanding Persistent Atrial FibrillationUnited States
-
Medtronic Bakken Research CenterTerminatedLongstanding Persistent Atrial FibrillationSpain, Germany, Israel, Italy
-
Medtronic Cardiac SurgeryRecruitingPersistent Atrial Fibrillation | Longstanding Persistent Atrial FibrillationUnited States