Pulsed Field Ablation in the Coronary Sinus: Feasibility and Safety of a Novel Approach for Mitral Isthmus Block

May 9, 2026 updated by: Shanghai Zhongshan Hospital

Safety, Efficacy and Mid-term Outcomes of Pulsed Field Ablation for Mitral Isthmus Ablation Through Epicardial Approach

Why This Study Is Important

  • Many patients with atrial fibrillation (AF) continue to experience abnormal heart rhythms even after receiving standard treatments.
  • Standard heat-based energy can be difficult to use in these areas because fast blood flow cools the tissue, and excessive heat may damage nearby structures like the right coronary artery.

Our Approach

  • Investigators are testing a newer technology called pulsed field ablation (PFA).
  • Unlike traditional methods, PFA uses ultra-short electrical pulses rather than heat to target heart cells specifically while protecting neighboring nerves and blood vessels.
  • This study focuses on applying this energy within the coronary sinus to help achieve a more complete and lasting electrical block for the mitral isthmus.

What To Expect

  • This study involves 30 participants who are already undergoing a catheter ablation procedure for atrial fibrillation.
  • The research team will monitor how successful the procedure is at immediately stopping the abnormal electrical signals.
  • Participants will have follow-up visits over six months to check for any returning heart rhythm issues and will receive a specialized heart scan (CTA) to ensure the nearby coronary arteries remain healthy

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Study Type

Observational

Enrollment (Estimated)

30

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

  • Adult
  • Older Adult

Accepts Healthy Volunteers

N/A

Sampling Method

Non-Probability Sample

Study Population

The study population consists of 30 consecutive participants who underwent catheter ablation for atrial fibrillation at Zhongshan Hospital, Fudan University. This cohort includes:

  • Clinical Presentation: The group is composed of paroxysmal atrial fibrillation and persistent atrial fibrillation.
  • Age Profile: All participants are between 18 and 75 years of age.
  • Treatment Context: Every patient in this population required substrate modification involving linear ablation at the mitral isthmus (MI) and within the coronary sinus (CS).
  • Health Status: The population excludes individuals with severe heart failure (NYHA Class III or IV), advanced renal failure eGFR<30mL/min/1.73m²), or a history of heart surgery and left atrial appendage occlusion

Description

Inclusion Criteria:

  • Symptomatic Atrial Fibrillation: participants must have a diagnosis of symptomatic paroxysmal or persistent atrial fibrillation.
  • Documentation: The arrhythmia must be documented by electrocardiogram or Holter monitoring.
  • Age Range: participants must be between 18 and 75 years of age.
  • Study Compliance: participants must be willing and able to comply with the post-procedural follow-up schedule.
  • Procedural Requirement: All patients must be candidates for linear ablation at the mitral isthmus (MI) and coronary sinus (CS) for substrate modification.

Exclusion Criteria:

  • Prior Cardiac Procedures: Patients with a history of prior heart surgery or Left Atrial Appendage Occlusion (LAAO) are excluded.
  • Heart Failure Severity: Individuals classified with New York Heart Association (NYHA) functional class III or IV are ineligible.
  • Renal Impairment: Patients with advanced renal failure, defined as an estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73m², are excluded.
  • Intracardiac Thrombus: Any patient with a left atrial thrombus identified via transesophageal echocardiography (TEE) is excluded.

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

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Acute Procedural Success of Mitral Isthmus Isolation
Time Frame: Intraoperative (immediately following the ablation procedure)
The percentage of patients achieving acute bidirectional conduction block across the mitral isthmus (MI) line. Bidirectional block is confirmed using differential pacing techniques from the left atrial appendage and the distal coronary sinus after completing both endocardial and intra-coronary sinus pulsed field ablation
Intraoperative (immediately following the ablation procedure)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Shanghai Zhongshan Hospital

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 (Estimated)

May 15, 2026

Primary Completion (Estimated)

May 31, 2026

Study Completion (Estimated)

June 30, 2026

Study Registration Dates

First Submitted

May 4, 2026

First Submitted That Met QC Criteria

May 4, 2026

First Posted (Actual)

May 11, 2026

Study Record Updates

Last Update Posted (Actual)

May 13, 2026

Last Update Submitted That Met QC Criteria

May 9, 2026

Last Verified

April 1, 2026

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • B2025-700 (Sun Yat-sen University Cancer Center)

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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