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Atrial Fibrillation ParoxysmalNCT05328882

Early Recurrences of Atrial Arrhythmias and Their Impact on Late Recurrence After Pulmonary Vein Isolation With Pulsed Field Ablation of Paroxysmal Atrial Fibrillation

An observational study of Atrial Fibrillation Paroxysmal and Recurrence, run by University of Split, School of Medicine at 1 site in Croatia.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

This is a prospective, single-arm study conducted in University Hospital of Split, Department of Cardiology. Patients treated with PFA for symptomatic paroxysmal atrial fibrillation will be asked to participate in the study. Read more about this study

Who is it for?
Ages 18 to 75 years
Conditions the study is for
Atrial Fibrillation Paroxysmal, Recurrence
What is being tested?
Monitoring of paroxysmal atrial fibrillation recurrence after pulsed field catheter ablation
How many people
40 participants
Where
1 siteCroatia
Study dates
17 Nov 2021to 17 May 2024
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 75 years
  • All sexes
  • Adult, Older adult

Study population: Patients with symptomatic paroxysmal atrial fibrillation after at least one failed or intolerant group I or III of antiarrhythmic drug that are eligible for PFA and are willing and able to provide informed consent.

Who may be able to join

  • Age >18
  • Index PFA procedure after one failed or intolerant group I or III of the antiarrhythmic drug in patients with symptomatic paroxysmal AF (AF with self-terminating episodes lasting no longer than 7 continuous days)
  • Willing and able to provide informed consent.

Who cannot join

  • Any known contraindication to AF ablation or anticoagulation.
  • History of previous left atrial ablation or surgical treatment.
  • Secondary AF due to reversible or non-cardiac cause such as thyroid disease and electrolyte imbalance.
  • Asymptomatic AF patients, persistent AF, permanent AF patients.
  • History of clotting or bleeding disease or cryoglobulinemia.
  • Pregnant or lactating.
  • Other conditions that may make the patient a poor candidate for procedure such as mental illness, terminal illness, vulnerable patient population.

Trial locations and contacts

1 site in 1 country.

Lucija Lisica, MD contact

+385995094697

lucijalisica21@gmail.com

Zrinka Jurišić, Ass. Prof., MD contact

+385915262844

zrinkacn@gmail.com

Croatia1 site, 1 recruiting
  • University Hospital Center Split

    Split, Split-Dalmatia County, 21000

    Zrinka Jurišić, Ass. Prof., MD, +385915262844, zrinkacn@gmail.com

    Lucija Lisica, MD

    Recruiting

Other trials in Croatia

About this study

This is a prospective, single-arm study conducted in University Hospital of Split, Department of Cardiology. Patients treated with PFA for symptomatic paroxysmal atrial fibrillation will be asked to participate in the study. An implantable loop recorder (ILR) will be placed immediately after the PFA procedure for rhythm monitoring. Early recurrences will be subsequently divided into very early recurrences (up to 1 month post-procedure) and early recurrences (1-3 months post-procedure). Late recurrences will be defined as those 3 to 12 months post-procedure. Patients will be monitored routinely through follow up visits during which ILR will be interrogated and eventual symptoms will be assessed. Follow-up visits will be scheduled 1, 3, 6, 12 months post-procedure. Median follow-up will be 12 months. Data for the study will be obtained from a loop monitor to assess the arrhythmia burden during follow-up visits in the University Hospital of Split Arrhythmia Clinic.

Read the detailed description

This is a prospective, single-arm study conducted in the University Hospital of Split, Department of Cardiology. Patients treated with PFA for symptomatic paroxysmal atrial fibrillation will be asked to participate in the study. An implantable loop recorder (ILR) will be placed immediately after the PFA procedure for rhythm monitoring. Early recurrences will be subsequently divided into very early recurrences (up to 1-month post-procedure) and early recurrences (1-3 months post-procedure). Late recurrences will be defined as those 3 to 12 months post-procedure. Patients will be monitored routinely through follow-up visits during which ILR will be interrogated and eventual symptoms will be assessed. Follow-up visits will be scheduled 1, 3, 6, and 12 months post-procedure. The median follow-up will be 12 months. Data for the study will be obtained from a loop monitor to assess the arrhythmia burden during follow-up visits in the University Hospital of Split Arrhythmia Clinic.

For PVI, the "single-shot" multielectrode PFA catheter will be used. This catheter consists of 5 splines, with 4 electrodes per spline and 1 electrode available for intracardiac electrogram recording or 3-dimensional electroanatomic visualization. When used in conjunction with the PFA generator, an electric field is created that ablates tissue using irreversible electroporation. The catheter shape is changed through the manipulation of a slider mechanism on the handle of the catheter. The diameter of the catheter is measured in the fully deployed "flower" configuration and is available in 2 sizes (31 or 35 mm). Energy is delivered through all of the electrodes in a proprietary sequence.

All patients will be asked to provide written informed consent for their respective protocol before undergoing the study.

All procedures will be performed with conscious sedation and propofol bolus synchronized to sets of PFA applications. The procedures will be performed with uninterrupted oral anticoagulation, and left atrial thrombus will be excluded either through pre-procedure CT or intracardiac echocardiography (ICE) (AcuNav, Siemens, Munich, Germany) at the time of the procedure. Pre- and post-ablation diaphragm motion will be evaluated to observe changes in phrenic nerve function during the procedure. Esophageal temperature monitoring will not be utilized due to the nonthermal nature of PFA.

A single transseptal puncture will be performed with an 8.5-F sheath and exchanged for the 13-F PFA sheath in the left atrium, or a transseptal puncture will be performed directly with the PFA sheath. Intravenous heparin will be administered as boluses and continuous infusions to obtain an activated clotting time ≥300 s prior to ablation and throughout the procedure. A 0.035-inch, 180-cm extra-stiff, straight guidewire will be used to cannulate each vein over which the multielectrode PFA catheter will be deployed into the desired shape and advanced into position at the antrum of each vein. The antral level of catheter positioning will be monitored with ICE imaging and fluoroscopy. Patients with left common PV anatomy will receive therapy at the level of the common antrum with 2 sets of therapy delivered, 1 with the guidewire in a superior branch and 1 with the guidewire in an inferior branch.

Acute isolation of the treated vein will be determined by the mapping electrodes on each spline of the PFA catheter. Once all veins have been treated, a 3-dimensional electroanatomic voltage map will be created to confirm PV isolation and visualize the level of isolation of each lesion set. Entrance or exit block will be confirmed following a 20-min wait period after the last PFA application was delivered with a circular mapping catheter (Lasso, Biosense Webster, Irvine, California).

All patients will be implanted with an ILR (Medtronic Reveal LINQTM; Medtronic, Minneapolis, MN). After ablation procedure, the ILR will be inserted subcutaneously in the left fourth intercostal space. The procedure itself takes up to 15 minutes and local anesthetic will be administered prior to the implantation. The antiarrhythmic drugs, except beta-blocker, will be routinely discontinued.

Being tested
Monitoring of paroxysmal atrial fibrillation recurrence after pulsed field catheter ablation
Keywords
Pulsed field ablation
Medical subject headings
Atrial Fibrillation, Recurrence

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Monitoring of paroxysmal atrial fibrillation recurrence after pulsed field catheter ablationOther

    The implanted loop recorder will be interrogated to see how many patients had an early recurrence of AF (up to 3 months after the procedure). Then the late recurrence rate will be compared (3-12 months post-procedure) between groups with and without early recurrences.

Study groups in NCT05328882
Study groupRoleWhat they receive
ERAF after PFAPatients with an early recurrence after pulsed field ablation of paroxysmal atrial fibrillation.
Receives: Other: Monitoring of paroxysmal atrial fibrillation recurrence after pulsed field catheter ablation
no ERAF after PFAPatients without an early recurrence after pulsed field ablation of paroxysmal atrial fibrillation.
Receives: Other: Monitoring of paroxysmal atrial fibrillation recurrence after pulsed field catheter ablation

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number of participants with AF recurrence 3-12 months post-procedure

    Number of participants with AF recurrence 3-12 months post-procedure (AF burden defined by loop recorder findings)

    Measured: 12 months

Secondary outcomes (2)
  1. Adverse event rate

    Adverse event rate defined as any untoward medical occurrence, unintended disease or injury related to all aspects of the ablation procedure (death, air embolism, myocardial infarction, stroke, esophageal injury, PV stenosis, puncture site hematoma, vascular lesions).

    Measured: 12 months

  2. Number of patients with very early AF recurrence (within 1 month post procedure)

    Number of patients with very early AF recurrence (within 1 month post procedure)

    Measured: 12 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted14 Apr 2022
  2. Study start17 Nov 2021
  3. Primary completion17 May 2024 (estimated)
  4. Study completion17 May 2024 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
40 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05328882
Sponsor's protocol ID
2181-147/01/06/M.S.-21-02
Status last verified
Oct 2023
First submitted
7 Apr 2022
Last updated
6 Oct 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
Yes: All IPD that underlie results in a publication will be shared.

Publications

  • Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomstrom-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL; ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021 Feb 1;42(5):373-498. doi: 10.1093/eurheartj/ehaa612. No abstract available.

    PubMed 32860505
  • Tanno K, Kobayashi Y, Kurano K, Kikushima S, Yazawa T, Baba T, Inoue S, Mukai H, Katagiri T. Histopathology of canine hearts subjected to catheter ablation using radiofrequency energy. Jpn Circ J. 1994 Feb;58(2):123-35. doi: 10.1253/jcj.58.123.

    PubMed 8196154
  • Grubman E, Pavri BB, Lyle S, Reynolds C, Denofrio D, Kocovic DZ. Histopathologic effects of radiofrequency catheter ablation in previously infarcted human myocardium. J Cardiovasc Electrophysiol. 1999 Mar;10(3):336-42. doi: 10.1111/j.1540-8167.1999.tb00680.x.

    PubMed 10210495
  • Malmborg H, Christersson C, Lonnerholm S, Blomstrom-Lundqvist C. Comparison of effects on coagulation and inflammatory markers using a duty-cycled bipolar and unipolar radiofrequency pulmonary vein ablation catheter vs. a cryoballoon catheter for pulmonary vein isolation. Europace. 2013 Jun;15(6):798-804. doi: 10.1093/europace/eus411. Epub 2013 Jan 29.

    PubMed 23362019
  • Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Cosedis Nielsen J, Curtis AB, Davies DW, Day JD, d'Avila A, Natasja de Groot NMS, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T; Document Reviewers:. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace. 2018 Jan 1;20(1):e1-e160. doi: 10.1093/europace/eux274. No abstract available.

    PubMed 29016840
  • Willems S, Khairy P, Andrade JG, Hoffmann BA, Levesque S, Verma A, Weerasooriya R, Novak P, Arentz T, Deisenhofer I, Rostock T, Steven D, Rivard L, Guerra PG, Dyrda K, Mondesert B, Dubuc M, Thibault B, Talajic M, Roy D, Nattel S, Macle L; ADVICE Trial Investigators*. Redefining the Blanking Period After Catheter Ablation for Paroxysmal Atrial Fibrillation: Insights From the ADVICE (Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination) Trial. Circ Arrhythm Electrophysiol. 2016 Aug;9(8):e003909. doi: 10.1161/CIRCEP.115.003909.

    PubMed 27516462
  • Mariani MA, Pozzoli A, Maat G, Alfieri OR, Benussi S. What Does The Blanking Period Blank? J Atr Fibrillation. 2015 Dec 31;8(4):1268. doi: 10.4022/jafib.1268. eCollection 2015 Dec.

    PubMed 27957225
  • Reddy VY, Anic A, Koruth J, Petru J, Funasako M, Minami K, Breskovic T, Sikiric I, Dukkipati SR, Kawamura I, Neuzil P. Pulsed Field Ablation in Patients With Persistent Atrial Fibrillation. J Am Coll Cardiol. 2020 Sep 1;76(9):1068-1080. doi: 10.1016/j.jacc.2020.07.007.

    PubMed 32854842
  • Calkins H, Gache L, Frame D, Boo LM, Ghaly N, Schilling R, Deering T, Duytschaever M, Packer DL. Predictive value of atrial fibrillation during the postradiofrequency ablation blanking period. Heart Rhythm. 2021 Mar;18(3):366-373. doi: 10.1016/j.hrthm.2020.11.020. Epub 2020 Nov 24.

    PubMed 33242668
  • Reddy VY, Dukkipati SR, Neuzil P, Anic A, Petru J, Funasako M, Cochet H, Minami K, Breskovic T, Sikiric I, Sediva L, Chovanec M, Koruth J, Jais P. Pulsed Field Ablation of Paroxysmal Atrial Fibrillation: 1-Year Outcomes of IMPULSE, PEFCAT, and PEFCAT II. JACC Clin Electrophysiol. 2021 May;7(5):614-627. doi: 10.1016/j.jacep.2021.02.014. Epub 2021 Apr 28.

    PubMed 33933412
  • Reddy VY, Neuzil P, Koruth JS, Petru J, Funosako M, Cochet H, Sediva L, Chovanec M, Dukkipati SR, Jais P. Pulsed Field Ablation for Pulmonary Vein Isolation in Atrial Fibrillation. J Am Coll Cardiol. 2019 Jul 23;74(3):315-326. doi: 10.1016/j.jacc.2019.04.021. Epub 2019 May 11.

    PubMed 31085321
  • Kawamura I, Neuzil P, Shivamurthy P, Petru J, Funasako M, Minami K, Kuroki K, Dukkipati SR, Koruth JS, Reddy VY. Does pulsed field ablation regress over time? A quantitative temporal analysis of pulmonary vein isolation. Heart Rhythm. 2021 Jun;18(6):878-884. doi: 10.1016/j.hrthm.2021.02.020. Epub 2021 Feb 27.

    PubMed 33647464
  • Stewart MT, Haines DE, Verma A, Kirchhof N, Barka N, Grassl E, Howard B. Intracardiac pulsed field ablation: Proof of feasibility in a chronic porcine model. Heart Rhythm. 2019 May;16(5):754-764. doi: 10.1016/j.hrthm.2018.10.030. Epub 2018 Oct 30.

    PubMed 30385383
  • Kim YG, Boo KY, Choi JI, Choi YY, Choi HY, Roh SY, Shim J, Kim JS, Kim YH. Early Recurrence Is Reliable Predictor of Late Recurrence After Radiofrequency Catheter Ablation of Atrial Fibrillation. JACC Clin Electrophysiol. 2021 Mar;7(3):343-351. doi: 10.1016/j.jacep.2020.09.029. Epub 2021 Jan 27.

    PubMed 33516711

Questions about this trial

What is this clinical trial studying?

An observational study of Atrial Fibrillation Paroxysmal and Recurrence, run by University of Split, School of Medicine at 1 site in Croatia.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 6 Oct 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Croatia. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Lucija Lisica, MD (+385995094697, lucijalisica21@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number of participants with AF recurrence 3-12 months post-procedure (time frame: 12 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05328882, which also lists 14 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Oct 2023.

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