AIC Genotyping Study
Genetic Susceptibility to AF-Induced Cardiomyopathy
Studieoversigt
Status
Betingelser
Detaljeret beskrivelse
Atrial Fibrillation (AF) is the most common heart rhythm disorder affecting 1 in 3-5 adults over 45. Although most patients tolerate AF, in some people it can weaken the main pump of the heart (left ventricle), causing heart failure. It is not known why some people develop heart failure during AF and others do not. We propose that individual vulnerability is due to specific genetic abnormalities that do not cause problems until they develop AF. These genetic abnormalities have been identified in patients who develop heart failure with the onset of other stressors, such as alcohol or pregnancy.
Our study will identify 92 patients with AF-triggered heart failure, defined by having heart failure during AF but resolved after the AF was treated using a procedure called catheter ablation. We will measure how common these genetic variations are seen in patients with AF-triggered heart failure and compare them with 184 patients who have AF but don't develop heart failure (negative comparators) and 23 patients who do develop heart failure but do not recover after AF treatment (positive comparators).We shall only test for a limited number of clearly disease-causing genetic variants to ensure cost- effectiveness and minimise the risk of identifying genes of unclear significance.
If we find a genetic association, doctors could: (1) identify patients more likely to develop weakness before the AF becomes persistent, (2) fast-track at-risk patients for catheter ablation treatment, (3) offer family screening where appropriate, and (4) avoid unnecessary testing in low-risk patients. This would directly improve care for people in East London and beyond by personalising AF treatment and preventing avoidable heart failure.
Undersøgelsestype
Tilmelding (Anslået)
Kontakter og lokationer
Studiekontakt
- Navn: Nikhil Ahluwalia, MBBS, PhD
- Telefonnummer: +44(0) 20 3465 5398
- E-mail: nikhil.ahluwalia@nhs.net
Studiesteder
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London, Det Forenede Kongerige, EC1A 7BE
- Rekruttering
- St Bartholomew's Hospital, Barts Health NHS Trust
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Kontakt:
- Nikhil Ahluwalia
- E-mail: nikhil.ahluwalia@nhs.net
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Deltagelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
- Voksen
- Ældre voksen
Tager imod sunde frivillige
Prøveudtagningsmetode
Studiebefolkning
Beskrivelse
INCLUSION:
AIC (Cases):
- Age ≥18
- Persistent AF before index catheter ablation or cardioversion
- LVEF ≤40% during rate-controlled (resting HR <100bpm, mean HR on 24-hour Holter <100bpm) AF prior to index catheter ablation or cardioversion
- LVEF normalisation (LVEF ≥55%) in SR, post-catheter ablation or cardioversion (≥3 months post-catheter ablation or cardioversion), no AF (>30 seconds of continuous AF) detected outside blanking period (8 weeks post-catheter ablation), and with no new introduction of any new or increased dose of heart failure guideline-directed medical therapy (GDMT) (renin-angiotensin-aldosterone system inhibitors (RAASi), Sodium Glucose Co-transporter 2 (SLGT2) inhibitors, increased dose of beta-blocker (BB), mineralocorticoid receptor antagonist (MRA))
AF-pEF (Negative controls):
- Age ≥18
- Persistent AF before index catheter ablation or cardioversion
- LVEF ≥55% during rate-controlled (resting HR <100bpm) AF. AIC-genotyping study, v1.7, 27.01.26 Page 13 of 28
AF/HF non-responders (Positive controls)
- Age ≥18
- Persistent AF before index catheter ablation or cardioversion
- LVEF ≤40% during rate-controlled (resting HR <100bpm) AF before index catheter ablation or cardioversion.
- Persistent LVSD (LVEF ≤40%) in SR, post-catheter ablation or cardioversion (≥3 months post-catheter ablation or cardioversion), no AF (>30 seconds of continuous AF) detected outside blanking period (8 weeks post-catheter ablation) and with no change in heart failure GDMT (RAASi, SGLT2 inhibitors, increased dose of BB, MRA).
EXCLUSION:
AIC (Cases).
- No alternative cause for LVSD (ischemic cardiomyopathy/non-ischaemic cardiomyopathy before AF diagnosis, primary valve disease, inherited cardiomyopathy
- Any pregnancy during AF or in the 12 months preceding LVSD onset.
- Alcohol intake >21 units/week
- Any history of cardiotoxic chemotherapy
AF-pEF (Negative controls)
- No known cause for LVSD (ischemic cardiomyopathy/non-ischaemic cardiomyopathy before AF diagnosis, primary valve disease, inherited cardiomyopathy).
- Any pregnancy during AF or in the 12 months preceding LVSD onset.
- Alcohol intake >21 units/week.
- Any history of cardiotoxic chemotherapy.
AF/HF non-responders (Positive controls)
- No alternative cause for LVSD (ischemic cardiomyopathy/non-ischaemic cardiomyopathy before AF diagnosis, primary valve disease, inherited cardiomyopathy).
- Any pregnancy during AF or in the 12 months preceding LVSD onset.
- Alcohol intake >21 units/week.
- Any history of cardiotoxic chemotherapy.
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
Kohorter og interventioner
Gruppe / kohorte |
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AF induced Cardiomyopathy (Cases)
Patients with LVSD during rate-controlled, persistent AF who improve their LVEF after sustained SR is achieved using catheter ablation or cardioversion.
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AF-preserved EF (Negative controls)
Patients without LVSD during rate-controlled, persistent AF
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AF/HF non-responders (Positive controls)
Patients with LVSD during rate-controlled, persistent AF who do not significantly improve their LVEF after sustained SR is achieved using catheter ablation or cardioversion.
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Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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DCM gene prevalence relative to negative control
Tidsramme: On day of baseline testing (1 day)
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Group difference between AIC vs AF-pEF in P/LP prevalence from DCM panel
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On day of baseline testing (1 day)
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Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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DCM gene prevalence relative to positive control
Tidsramme: On day of baseline testing (1 day)
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Group difference between AIC vs AF/HF non-responders in P/LP prevalence.
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On day of baseline testing (1 day)
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Andre resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Genotype-recovery time association
Tidsramme: 12 months post-ablation time-point (independent of study enrolment date)
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Time from durable SR to LVEF normalisation: by genotype (TTNtv; any P/LP): HR from Cox models. Change in LVEF (post-SR minus pre-SR) by genotype: β from linear regression. Rapid recovery proportion (normalisation ≤90 days) by genotype |
12 months post-ablation time-point (independent of study enrolment date)
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Samarbejdspartnere og efterforskere
Sponsor
Efterforskere
- Ledende efterforsker: Shohreh Honarbakhsh, MBBS, PhD, Queen Mary University of London
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Primær færdiggørelse (Anslået)
Studieafslutning (Anslået)
Datoer for studieregistrering
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
- 368232
Plan for individuelle deltagerdata (IPD)
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