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PULSed Field Ablation for Atrial Fibrillation Using a Balloon for Early Intervention - Study (PULSE)

21 agosto 2026 aggiornato da: Asklepios proresearch

PULSed Field Ablation for Atrial Fibrillation Using a Balloon for Early Intervention - Study - The "PULSE - Study"

This study is a prospective, multicenter, randomized, open-label, blinded end-point, controlled clinical trial to investigate the impact of first line pulsed field ablation during 12 months follow-up in patients with early-stage paroxysmal or persistent atrial fibrillation (<3 years) compared to usual care, defined as OMT.

Panoramica dello studio

Stato

Reclutamento

Descrizione dettagliata

Atrial fibrillation (AF) is a progressive arrhythmia associated with significant morbidity and mortality and burden for our health care system. Early rhythm-control therapy was beneficial regarding cardiovascular outcomes in patients with symptomatic and asymptomatic AF. Recent studies introducing first line Cryo Balloon based catheter ablation EARLY-AF and STOP -AF provided strong evidence supporting early catheter ablation over pharmacologic rhythm control in the paroxysmal setting of AF. Ongoing studies are challenging the current concept investigating the expansion of early rhythm control also to all types of clinically diagnosed AF using cryo ablation. With the advent of pulsed field ablation (PFA), a third energy source-alongside cryothermal and radiofrequency (RF) ablation-has been established for the effective treatment of atrial fibrillation (AF). PFA induces so-called irreversible electroporation, thereby enabling successful ablation of myocardial tissue. Different cell types exhibit varying susceptibility and threshold levels for irreversible electroporation when exposed to PFA. Carefully tailored PFA pulse trains deliver sufficient energy to induce irreversible electroporation while avoiding excessive thermal effects on the surrounding tissue. Consequently, PFA enables selective targeting of myocardial tissue while minimizing collateral injury. This characteristic may translate into improved safety and efficacy in the treatment of AF. In contrast, thermal ablation techniques such as cryoablation and RF ablation inherently rely on substantial temperature changes, either cooling or heating, which may adversely affect adjacent anatomical structures including nerves (e.g., resulting in phrenic nerve palsy), vascular structures, and extracardiac tissues such as the esophagus. The occurrence of these potentially life-threatening complications may be reduced or possibly avoided using PFA. Over recent years, various PFA catheter designs as well as different PFA energy delivery settings have been introduced to enable effective and safe pulmonary vein isolation (PVI). A broad spectrum of catheter configurations-including focal single-tip catheters, pentaspline multielectrode systems, and balloon-based technologies-has been incorporated into clinical practice. Substantial comparative data evaluating PFA against conventional thermal ablation modalities (cryoablation and RF ablation) are now available. To date, no significant differences in acute procedural success rates, procedural parameters, or clinical outcome measures have been consistently observed, although one randomized trial demonstrated a trend toward improved outcomes with PFA. Across these studies, procedure duration was significantly shorter with PFA compared with conventional thermal ablation, representing an additional potential advantage of this treatment modality. More recent studies suggest that catheter ablation-particularly PFA-based ablation-for AF patients without documented recurrence during follow-up may be associated with a reduction in overall ischemic stroke events. These findings indicate that catheter ablation of AF may confer additional benefits in preventing adverse cardiovascular outcomes compared with medical therapy alone. Even in cases of AF recurrence, catheter ablation has been shown not only to significantly reduce AF burden but also to slow the progression from paroxysmal to persistent AF, the latter generally being associated with less favorable clinical outcomes compared with ablation performed during earlier disease stages. Despite the availability of effective antiarrhythmic drug therapy for AF, long-term pharmacological treatment is frequently limited by intolerance, side effects, or insufficient efficacy in a substantial proportion of patients. Nevertheless, large, randomized trials directly comparing PFA-based AF ablation with optimized medical therapy remain scarce.

Therefore, the PULSE study aims to evaluate the impact of PFA using a balloon-based catheter system for the treatment of AF on the maintenance of sinus rhythm compared with optimized medical therapy. In addition, the study will assess AF disease progression in patients with early-stage atrial fibrillation, including both symptomatic and asymptomatic individuals with paroxysmal or early persistent AF.

Tipo di studio

Interventistico

Iscrizione (Stimato)

264

Fase

  • Non applicabile

Contatti e Sedi

Questa sezione fornisce i recapiti di coloro che conducono lo studio e informazioni su dove viene condotto lo studio.

Contatto studio

Backup dei contatti dello studio

Luoghi di studio

      • Bad Oeynhausen, Germania
        • Non ancora reclutamento
        • HZD Bad Oeynhausen
        • Contatto:
          • Philipp Sommer, MD
      • Cologne, Germania
        • Non ancora reclutamento
        • Uniklinik Köln
        • Contatto:
          • Daniel Steven, MD
      • Düsseldorf, Germania
        • Non ancora reclutamento
        • Uniklinik Düsseldorf
        • Contatto:
          • Obaida Rana, MD
      • Frankfurt, Germania
        • Non ancora reclutamento
        • CCB Frankfurt
        • Contatto:
          • Melanie Gunawardene, MD
      • Giessen, Germania
        • Non ancora reclutamento
        • Uniklinik Gießen
        • Contatto:
          • Borislav Dinov, MD
      • Hamburg, Germania, 20099
        • Reclutamento
        • Arian Sultan
        • Contatto:
      • Herne, Germania
        • Non ancora reclutamento
        • Marien Hospital Herne
        • Contatto:
          • Christian Ukena, MD
      • Leipzig, Germania
        • Non ancora reclutamento
        • Leipzig Herzzentrum HZL
        • Contatto:
          • Kerstin Bode, MD
      • Neuss, Germania
        • Non ancora reclutamento
        • Lukas Krankenhaus Neuss
        • Contatto:
          • Torsten Becker, MD
      • Nuremberg, Germania
        • Non ancora reclutamento
        • Klinikum Nürnberg
        • Contatto:
          • Thomas Deneke, MD

Criteri di partecipazione

I ricercatori cercano persone che corrispondano a una certa descrizione, chiamata criteri di ammissibilità. Alcuni esempi di questi criteri sono le condizioni generali di salute di una persona o trattamenti precedenti.

Criteri di ammissibilità

Età idonea allo studio

  • Adulto
  • Adulto più anziano

Accetta volontari sani

No

Descrizione

Inclusion Criteria:

  • Adults (≥18 years) with symptomatic or asymptomatic, paroxysmal or persistent atrial fibrillation
  • First diagnosis of AF within the last 36 months
  • At least one documented episode of AF on ECG, Holter monitoring, or eligible Smart Watch Device
  • No prior catheter ablation for AF

Exclusion Criteria:

  • Persistent AF >3 years or longstanding persistent AF
  • Previous AF-Ablation
  • Ongoing continuous AAD therapy with Amiodarone at baseline
  • History of failed continuous AAD therapy with > 1 agent. Exceptions are Beta blocker, Verapamil or "pill in the pocket"-therapy
  • Left Atrial Volume Index (LAVI) > 50mL/m2
  • Severe mitral regurgitation
  • Contraindications to anticoagulation therapy
  • Severe pulmonary or renal disease
  • Pregnancy, active cancer disease
  • Any condition or disease which is contraindication for AF ablation within 21 days or Anti-Arrhythmic Drug (AAD)

Piano di studio

Questa sezione fornisce i dettagli del piano di studio, compreso il modo in cui lo studio è progettato e ciò che lo studio sta misurando.

Come è strutturato lo studio?

Dettagli di progettazione

  • Scopo principale: Trattamento
  • Assegnazione: Randomizzato
  • Modello interventistico: Assegnazione parallela
  • Mascheramento: Separare

Armi e interventi

Gruppo di partecipanti / Arm
Intervento / Trattamento
Comparatore attivo: Group1: Pulsed Field-Ablation
Patients randomized in the intervention group should receive the PFA ablation within 21 days.
PFA (Pulse Field Ablation) - Pulmonary vein isolation ablation for atrial fibrillation
Nessun intervento: Group 2: Usual care
Patients randomized in the control group / usual care group will undergo optimal medical treatment (OMT), defined as antiarrhythmic drug therapy (AAD). Within 21 days patients in the control group should start or maintain on AAD therapy based on decision of the investigator and according to current ESC Guidelines.

Cosa sta misurando lo studio?

Misure di risultato primarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Freedom from any Atrial Tachyarrhythmia
Lasso di tempo: through 9 weeks to 12 months follow-up
Arrhythmia-free survival, defined as freedom from atrial fibrillation, atrial flutter, or atrial tachycardia lasting >30 seconds through 9 weeks to 12 months follow-up on ILR monitoring via blinded core lab or any 12 lead ECG on visits, ECG Holter monitoring, or on symptom driven event monitoring after a 8 week Blanking period (reviewed by a blinded endpoint review committee).
through 9 weeks to 12 months follow-up

Misure di risultato secondarie

Misura del risultato
Misura Descrizione
Lasso di tempo
AF Burden
Lasso di tempo: through 9 weeks to 12 months follow-up
Freedom from atrial fibrillation (AF) (>30 s) through 9 weeks to 12 months follow-up
through 9 weeks to 12 months follow-up
Burden of Atrial Tachycardia and Atrial Flutter
Lasso di tempo: through 9 weeks to 12 months follow-up
Freedom from atrial tachycardia and atrial flutter (AFL) (>30 s) through 9 weeks to 12 months follow-up
through 9 weeks to 12 months follow-up
Re-hospitalization rate
Lasso di tempo: up to 12 months follow-up
Re-hospitalization rate due to cardiovascular disease (e.g. AF, worsening of heart failure)
up to 12 months follow-up
AF Progression Timeline
Lasso di tempo: through 9 weeks to 12 months follow-up
Progression from paroxysmal to persistent AF trough 9 weeks to 12 months follow-up.
through 9 weeks to 12 months follow-up
Symptom Burden assessed by quality of life
Lasso di tempo: QoL will be measured at baseline and at 12 months of follow up evaluating the improvement of QoL within one year.

Symptom Burden, detected by Patient Questionnaires: Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) and MOCA.

The Montreal Cognitive Assessment (MoCA) is used as screening instrument for cognitive dysfunction.

The AFEQT questionnaire is used because it is specific to AF and validated in that subject population. From each AFEQT questionnaire, a single score will be calculated in line with AFEQT scoring guidelines and post-procedure values will be compared between the randomized arms.

QoL will be measured at baseline and at 12 months of follow up evaluating the improvement of QoL within one year.
Procedure-related complications
Lasso di tempo: up to 12 months follow-up
Procedure-related complications, including phrenic nerve injury, pulmonary vein stenosis, esophageal injury and stroke.
up to 12 months follow-up
HF Progression Markers
Lasso di tempo: up to 12 months follow-up
Progression of heart failure defined as trend in LV-EF and trend in BNP
up to 12 months follow-up

Collaboratori e investigatori

Qui è dove troverai le persone e le organizzazioni coinvolte in questo studio.

Investigatori

  • Investigatore principale: Arian Sultan, MD, Asklepios Klinik St. Georg
  • Investigatore principale: Stephan Willems, MD, Asklepios Klinik St. Georg

Pubblicazioni e link utili

La persona responsabile dell'inserimento delle informazioni sullo studio fornisce volontariamente queste pubblicazioni. Questi possono riguardare qualsiasi cosa relativa allo studio.

Pubblicazioni generali

Studiare le date dei record

Queste date tengono traccia dell'avanzamento della registrazione dello studio e dell'invio dei risultati di sintesi a ClinicalTrials.gov. I record degli studi e i risultati riportati vengono esaminati dalla National Library of Medicine (NLM) per assicurarsi che soddisfino specifici standard di controllo della qualità prima di essere pubblicati sul sito Web pubblico.

Studia le date principali

Inizio studio (Effettivo)

19 agosto 2026

Completamento primario (Stimato)

31 marzo 2030

Completamento dello studio (Stimato)

31 marzo 2031

Date di iscrizione allo studio

Primo inviato

20 maggio 2026

Primo inviato che soddisfa i criteri di controllo qualità

27 maggio 2026

Primo Inserito (Effettivo)

2 giugno 2026

Aggiornamenti dei record di studio

Ultimo aggiornamento pubblicato (Effettivo)

24 agosto 2026

Ultimo aggiornamento inviato che soddisfa i criteri QC

21 agosto 2026

Ultimo verificato

1 agosto 2026

Maggiori informazioni

Termini relativi a questo studio

Parole chiave

Altri numeri di identificazione dello studio

  • #4523 - PULSE Study

Informazioni su farmaci e dispositivi, documenti di studio

Studia un prodotto farmaceutico regolamentato dalla FDA degli Stati Uniti

No

Studia un dispositivo regolamentato dalla FDA degli Stati Uniti

No

Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .

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