- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04186169
Peri-Atrial Inflammatory Fat and Atrial Fibrillation
September 13, 2022 updated by: Johns Hopkins University
Preliminary Studies to Evaluate the Impact of Peri-Atrial Inflammatory Fat Tissue on Atrial Fibrillation Using Ultra-High Resolution CT
Atrial fibrillation (AF) impacts the lives of 30 million people worldwide.
Pulmonary vein isolation (PVI) by catheter ablation is effective for paroxysmal AF, but the success rate remains marginal at 60-80%.
For persistent AF, defined as continuous AF that sustains longer than 7 days, the success rate is even lower.
The low success rate of AF ablation reflects the fact that there is no effective target identified to modify the underlying substrate beyond PVI.
Recently, investigators have made an exciting discovery that higher mean CT attenuation values of peri-atrial fat tissue, correlated with inflammatory fat, are associated with higher incidence of recurrence after AF ablation.
In this protocol, investigators will investigate the clinical significance of peri-atrial inflammatory fat tissue in AF using ultra-high resolution CT.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Detailed Description
Investigators will prospectively enroll 200 adult participants referred to the Johns Hopkins Hospital for catheter ablation of atrial fibrillation (AF).
Investigators will first enroll participants with paroxysmal AF (n=100) to complete sensitivity analysis of inflammatory fat and potential target identification before enrolling participants with persistent AF (n=100).
All participants (n=200) will undergo pre-procedural CT using the ultra-high resolution CT scanner 3-4 days prior the ablation procedure to allow a sufficient amount of time for image processing.
In all participants (n=200), blood specimens will be collected immediately prior to the ablation procedure.
The participants with paroxysmal AF (n=100) will receive the standard of care, which is PVI, and the clinical outcome will be followed up to 12 months post-procedure.
In this group, investigators will conduct a sensitivity analysis to define the range of peri-left atrial (LA) fat tissue (in HU) that is associated with AF recurrence.
Investigators will also conduct computation of source-sink mismatch arising from wall thinning due to fat infiltration into the myocardium that favors functional block and local reentry.
For participants with persistent AF (n=100), investigators will conduct an exploratory clinical trial where the participants will be randomly assigned to 1) PVI group (n=50), or 2) PVI + inflammatory fat-targeted ablation group (n=50).
In the latter group, additional focal ablation will be performed beyond PVI to target the inflammatory fat tissue based on the result of the sensitivity analysis.
Randomization will be performed with the use of an automated computer-generated randomization algorithm.
The participants will be unaware of the group assignment, but the operators will not be blinded (single-blinded design).
In all patients, no ablation strategies beyond PVI except cavotricuspid isthmus (CTI) ablation for typical atrial flutter (AFL) will be allowed, such as linear lesions (e.g.
roof lines, mitral isthmus lines), and focal ablation to eliminate complex fractionated atrial electrograms (CFAE) and rotating drivers.
Study Type
Interventional
Enrollment (Anticipated)
200
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Hiroshi Ashikaga, MD, PhD
- Phone Number: 4106146076
- Email: hashika1@jhmi.edu
Study Locations
-
-
Maryland
-
Baltimore, Maryland, United States, 21287-0005
- Recruiting
- Johns Hopkins Hospital
-
Contact:
- Hiroshi Ashikaga
- Phone Number: 410-955-7534
- Email: hashika1@jhmi.edu
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 100 years (ADULT, OLDER_ADULT)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion criteria:
- Ages 18 to 100 years
- Adult men and women undergoing the first catheter ablation of AF for whom cardiac CT is clinically indicated to guide the procedure.
Exclusion criteria:
- Inability to provide consent
- Estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m^2
- Known history of anaphylaxis to radiocontrast
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
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 |
---|---|
PLACEBO_COMPARATOR: Arm 1: Paroxysmal AF - PVI arm
The subjects with paroxysmal AF undergo pulmonary vein isolation (PVI).
|
Catheter ablation
|
PLACEBO_COMPARATOR: Arm 2: Persistent AF - PVI arm
The subjects with persistent AF undergo pulmonary vein isolation (PVI).
|
Catheter ablation
|
EXPERIMENTAL: Arm 3: Persistent AF - PVI + Fat-targeted ablation
The subjects with persistent AF undergo pulmonary vein isolation (PVI) and additional ablation to target the inflammatory fat tissue
|
Catheter ablation
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Freedom from any documented episode of AF
Time Frame: 12 months
|
Freedom from any documented episode of AF lasting longer than 30 seconds after the performance of a single ablation procedure without the use of antiarrhythmic drugs (AADs).
No episode of AF occurring within the initial 3-month blanking period after ablation will be counted.
An episode of AF will be considered part of the primary outcome analyses if it lasts longer than 30 seconds and is documented by any form of monitoring, regardless of symptoms.
A repeat left atrial (LA) ablation procedure at any time will also be considered to constitute a recurrence for the purpose of the outcome analyses.
Participants who complete fewer than 3 months of follow-up and thus do not complete the blanking period will be excluded from endpoint analysis.
There will be no blanking period after a second procedure.
|
12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Freedom from documented AF after two ablation procedures
Time Frame: 12 months
|
Freedom from documented AF after two ablation procedures
|
12 months
|
Freedom from any documented atrial arrhythmia after one ablation procedure
Time Frame: 12 months
|
Freedom from any documented atrial arrhythmia after one ablation procedure
|
12 months
|
Freedom from any documented atrial arrhythmia after two ablation procedures
Time Frame: 12 months
|
Freedom from any documented atrial arrhythmia after two ablation procedures
|
12 months
|
Use of antiarrhythmia drugs (AADs)
Time Frame: 12 months
|
Use of antiarrhythmia drugs (AADs) will be measured as a categorical variable (Yes or No).
|
12 months
|
Procedure time
Time Frame: 12 months
|
Procedure time will be measured as a continuous variable (in minutes).
|
12 months
|
Occurrence of repeat procedures
Time Frame: 12 months
|
Occurrence of repeat procedures will be measured as a categorical variable (Yes or No).
|
12 months
|
Occurrence of peri-procedural complications
Time Frame: 30 days
|
Occurrence of peri-procedural complications will be measured as a categorical variable (Yes or No).
|
30 days
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Hiroshi Ashikaga, MD, PhD, Johns Hopkins University
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (ACTUAL)
February 19, 2021
Primary Completion (ANTICIPATED)
June 30, 2026
Study Completion (ANTICIPATED)
June 30, 2026
Study Registration Dates
First Submitted
December 2, 2019
First Submitted That Met QC Criteria
December 2, 2019
First Posted (ACTUAL)
December 4, 2019
Study Record Updates
Last Update Posted (ACTUAL)
September 14, 2022
Last Update Submitted That Met QC Criteria
September 13, 2022
Last Verified
September 1, 2022
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- IRB00210289
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
No
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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