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Atrial FibrillationPLAI-AFNCT05723536

PLAI-AF Trial: Hybrid Endo-epicardial Partial Left Atrial Isolation vs. Endocardial Ablation in Patients With Persistent Atrial Fibrillation

A study testing Partial Left Atrial Isolation and Catheter Ablation in people with Atrial Fibrillation and Persistent Atrial Fibrillation, run by Hospital Clinic of Barcelona at 1 site in Spain.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

In patients with symptomatic atrial fibrillation (AF), current clinical guidelines recommend ablation for rhythm control. While percutaneous ablation has good results in patients with paroxysmal AF, it is not clear which is the best technique in patients with persistent or long-standing persistent AF. Read more about this study

Who is it for?
Ages 18 to 75 years
What is being tested?
Partial Left Atrial Isolation and Catheter Ablation
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
80 participants
Where
1 siteSpain
Study dates
23 Oct 2023to 31 Dec 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

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
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients between the ages of 18 and 75, both inclusive, at the time of the consent date.
  • Patients with persistent atrial fibrillation refractory to at least one antiarrhythmic drug (Class I or III).
  • Signature of written informed consent.

Who cannot join

  • Continuous Persistent atrial fibrillation of more than 4 years.
  • Moderate to severe valvular heart disease.
  • Severe atrial dilatation (left appendage AP diameter > 55 mm or > 50ml/m2).
  • Patients requiring concomitant cardiac surgery or with previous cardiac surgery.
  • Left ventricular ejection fraction <40%.
  • History of pericarditis.
Show all 17Show fewer
  • Previous stroke.
  • Presence of active infection or sepsis, esophageal ulcer stricture and/or esophageal varices.
  • Patients with renal dysfunction defined as GFR less than or equal to 40 ml/min/m2.
  • Contraindication for chronic anticoagulation.
  • Patients who have undergone prior left atrial catheter ablation for atrial fibrillation or who are receiving treatment for ventricular arrhythmia.
  • Patients with severe chronic obstructive pulmonary disease considered GOLD III.
  • Patients with active neoproliferative disease or other concomitant disease where the medical team considers that ablation places the patient at unacceptable risk.
  • Pregnant, lactating women.
  • Patients who have previously presented allergic reactions to gadolinium.
  • Patients with claustrophobia that makes it impossible to perform nuclear magnetic resonance.
  • Persistent AF < 3 months

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Manuel Castellà, MD PhD contact

+34932275515

mcaste@clinic.cat

Nuria Pichel, MSc contact

+34932275733

pichel@clinic.cat

Spain1 site, 1 recruiting
  • Hospital Clínic de Barcelona

    Barcelona

    Manuel Castellà, MD PhD, +34932275515, mcaste@clinic.cat

    Nuria Pichel, MSc, +34932275733, pichel@clinic.cat

    Recruiting

Other trials in Spain

About this study

In patients with symptomatic atrial fibrillation (AF), current clinical guidelines recommend ablation for rhythm control.

While percutaneous ablation has good results in patients with paroxysmal AF, it is not clear which is the best technique in patients with persistent or long-standing persistent AF. Our group performed the first randomized study of thoracoscopic epicardial ablation vs. endocardial catheter ablation (FAST Trial), which showed better results for epicardial ablation but with a higher rate of complications. Hybrid epicardial and endocardial ablation strategies have recently been described sequentially, showing better results in patients with persistent AF, but 40% of patients are still refractory to ablation.

Read more

Our study aims to compare the conventional strategy (catheter ablation) with partial electrical isolation of the left atrium endo-epicardially (pulmonary veins, posterior wall and left atrial appendage) in a single procedure in the group of patients most refractory to ablation. Likewise, using magnetic resonance imaging and echocardiography to analyze the atrial remodeling factors that can predict the success and failure of both therapies.

Methodology: A 1:1 randomized clinical trial in patients with persistent and long-standing persistent AF in two groups: conventional ablation vs. partial endo-epicardial isolation. Prior to ablation, cardioversion will be performed and functionality and atrial size will be verified by echocardiography, delayed-enhancement / 4D flow magnetic resonance imaging (MRI), andelectrocardiographic imaging (ECGi) will detect the degree of fibrosis and atrial remodeling. During the ablation procedure, a continuous rhythm recording device will be implanted. Likewise, at three months the MRI will be repeated to detect post-ablation fibrosis. At six months the echocardiography will be performed to assess atrial function and size. AF recurence will be assessed using an internal loop recorder within a 1-year follow-up.

Main Expected Results: The expected results include: 1. an improvement in the rate of patients with no atrial arrhythmias recurrence in patients undergoing endo-epicardial ablation; 2. a lower AF burden in patients undergoing endo-epicardial ablation who have had recurrence; 3. To know the degree of atrial remodeling (including atrial fibrosis) associated with the success/failure of each technique; 4. To know the degree of fibrosis that both techniques produce; 5. To know the degree of ventricular function associated with the success/failure of each technique; 6. To know the degree of potentially lost atrial function; 7. To Compare the safety of both techniques

Being tested
Partial Left Atrial Isolation, Catheter Ablation
Medical subject headings
Atrial Fibrillation, Arrhythmias, Cardiac

What participants receive

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

  • Partial Left Atrial IsolationProcedure or surgery

    Partial electrical isolation of the left atrium endo-epicardially (pulmonary veins, posterior wall and left atrial appendage) and left atrial appendage isolation using Atriclip (Atricure, Mason OH, USA) in a single procedure in patients with persistent atrial fibrillation.

  • Catheter AblationProcedure or surgery

    Endocavity catheter ablation of persistent atrial fibrillation : pulmonary vein isolation and posterior wall isolation

Study groups in NCT05723536
Study groupRoleWhat they receive
PLAI (Partial Left Atrial Isolation)ExperimentalPartial electrical isolation of the left atrium endo-epicardially (pulmonary veins, posterior wall and left atrial appendage) and left atrial appendage isolation using Atriclip (Atricure, Mason OH, USA) in a single procedure in patients with persistent atrial fibrillation.
Receives: Procedure: Partial Left Atrial Isolation
CA (Catheter Ablation)Active comparatorEndocavity catheter ablation of persistent atrial fibrillation : pulmonary vein isolation and posterior wall isolation
Receives: Procedure: Catheter Ablation

What is being measured

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

  1. Absence of atrial arrhythmia

    Success or failure to be free of atrial arrhythmias (AF/AT/AFL) in the absence of class I and III antiarrhythmic drugs, or with the same antiarrhythmic treatment prior to study inclusion, after the 3-month blank period, during 12 months after the procedure and measured by internal loop recorder.

    Measured: 3-12 months post-surgery

Secondary outcomes (3)
  1. 90% reduction in baseline AF burden

    90% reduction in baseline AF burden in the absence of a new/increased dose of class I/III antiarrhythmic medication, as measured by implantable ECG recorder.

    Measured: 3-12 months post-surgery

  2. Pre-procedure atrial remodeling

    Pre-procedure atrial remodelling by MRI measuring fibrosis grade. Pre-procedure atrial remodelling by echocardiogram measuring size and function. Pre-procedure assessment of electrical atrial remodeling in AF and sinus rhythm using ECGi. Both measurements are in relation to primary endpoint success/failure in both groups.

    Measured: 3-months pre-surgery to 12 months post-surgery

  3. Post-procedure atrial remodeling

    Post-procedure atrial remodelling by MRI measuring fibrosis grade. Post-procedure atrial remodelling by echocardiogram measuring size and function. Both measurements are in relation to primary endpoint success/failure in both groups.

    Measured: 3-12 months post-surgery

Timeline

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

  1. First posted10 Feb 2023
  2. Study start23 Oct 2023
  3. Primary completion31 Dec 2027 (estimated)
  4. Study completion31 Dec 2027 (estimated)

Resources

More details

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

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
1:1 randomized clinical trial in patients with persistent and long-standing persistent AF in two groups: conventional ablation vs partial endo-epicardial isolation.
Masking
None (open label)
Enrolment
80 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05723536
Sponsor's protocol ID
HCB/2022/1059
Acronym
PLAI-AF
Status last verified
Sep 2026
First submitted
2 Feb 2023
Last updated
18 Sep 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Bisbal F, Guiu E, Cabanas-Grandio P, Berruezo A, Prat-Gonzalez S, Vidal B, Garrido C, Andreu D, Fernandez-Armenta J, Tolosana JM, Arbelo E, de Caralt TM, Perea RJ, Brugada J, Mont L. CMR-guided approach to localize and ablate gaps in repeat AF ablation procedure. JACC Cardiovasc Imaging. 2014 Jul;7(7):653-63. doi: 10.1016/j.jcmg.2014.01.014. Epub 2014 May 7.

    PubMed 24813966
  • Bisbal F, Benito E, Teis A, Alarcon F, Sarrias A, Caixal G, Villuendas R, Garre P, Soto N, Cozzari J, Guasch E, Junca G, Prat-Gonzalez S, Perea RJ, Bazan V, Tolosana JM, Arbelo E, Bayes-Genis A, Mont L. Magnetic Resonance Imaging-Guided Fibrosis Ablation for the Treatment of Atrial Fibrillation: The ALICIA Trial. Circ Arrhythm Electrophysiol. 2020 Nov;13(11):e008707. doi: 10.1161/CIRCEP.120.008707. Epub 2020 Oct 8.

    PubMed 33031713
  • Whitlock RP, Belley-Cote EP, Paparella D, Healey JS, Brady K, Sharma M, Reents W, Budera P, Baddour AJ, Fila P, Devereaux PJ, Bogachev-Prokophiev A, Boening A, Teoh KHT, Tagarakis GI, Slaughter MS, Royse AG, McGuinness S, Alings M, Punjabi PP, Mazer CD, Folkeringa RJ, Colli A, Avezum A, Nakamya J, Balasubramanian K, Vincent J, Voisine P, Lamy A, Yusuf S, Connolly SJ; LAAOS III Investigators. Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke. N Engl J Med. 2021 Jun 3;384(22):2081-2091. doi: 10.1056/NEJMoa2101897. Epub 2021 May 15.

    PubMed 33999547
  • Yorgun H, Canpolat U, Kocyigit D, Coteli C, Evranos B, Aytemir K. Left atrial appendage isolation in addition to pulmonary vein isolation in persistent atrial fibrillation: one-year clinical outcome after cryoballoon-based ablation. Europace. 2017 May 1;19(5):758-768. doi: 10.1093/europace/eux005.

    PubMed 28340073
  • DeLurgio DB, Crossen KJ, Gill J, Blauth C, Oza SR, Magnano AR, Mostovych MA, Halkos ME, Tschopp DR, Kerendi F, Taigen TL, Shults CC, Shah MH, Rajendra AB, Osorio J, Silver JS, Hook BG, Gilligan DM, Calkins H. Hybrid Convergent Procedure for the Treatment of Persistent and Long-Standing Persistent Atrial Fibrillation: Results of CONVERGE Clinical Trial. Circ Arrhythm Electrophysiol. 2020 Dec;13(12):e009288. doi: 10.1161/CIRCEP.120.009288. Epub 2020 Nov 13.

    PubMed 33185144
  • Maesen B, Pison L, Vroomen M, Luermans JG, Vernooy K, Maessen JG, Crijns HJ, La Meir M. Three-year follow-up of hybrid ablation for atrial fibrillation. Eur J Cardiothorac Surg. 2018 Apr 1;53(suppl_1):i26-i32. doi: 10.1093/ejcts/ezy117.

    PubMed 29590387
  • Boersma LV, Castella M, van Boven W, Berruezo A, Yilmaz A, Nadal M, Sandoval E, Calvo N, Brugada J, Kelder J, Wijffels M, Mont L. Atrial fibrillation catheter ablation versus surgical ablation treatment (FAST): a 2-center randomized clinical trial. Circulation. 2012 Jan 3;125(1):23-30. doi: 10.1161/CIRCULATIONAHA.111.074047. Epub 2011 Nov 14.

    PubMed 22082673
  • Castella M, Kotecha D, van Laar C, Wintgens L, Castillo Y, Kelder J, Aragon D, Nunez M, Sandoval E, Casellas A, Mont L, van Boven WJ, Boersma LVA, van Putte BP. Thoracoscopic vs. catheter ablation for atrial fibrillation: long-term follow-up of the FAST randomized trial. Europace. 2019 May 1;21(5):746-753. doi: 10.1093/europace/euy325.

    PubMed 30715255
  • Verma A, Jiang CY, Betts TR, Chen J, Deisenhofer I, Mantovan R, Macle L, Morillo CA, Haverkamp W, Weerasooriya R, Albenque JP, Nardi S, Menardi E, Novak P, Sanders P; STAR AF II Investigators. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med. 2015 May 7;372(19):1812-22. doi: 10.1056/NEJMoa1408288.

    PubMed 25946280

Questions about this trial

What is this clinical trial studying?

A study testing Partial Left Atrial Isolation and Catheter Ablation in people with Atrial Fibrillation and Persistent Atrial Fibrillation, run by Hospital Clinic of Barcelona at 1 site in Spain.

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 17 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: looking for participants now, as of the sponsor's last update on 18 Sep 2026. 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 Spain. 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?

This study is still under way. Results are not available in the source record yet.

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

Contact Manuel Castellà, MD PhD (+34932275515, mcaste@clinic.cat), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Absence of atrial arrhythmia (time frame: 3-12 months post-surgery). 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 NCT05723536, which also lists 9 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 18 Sep 2026.

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