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Atrial FibrillationAIR HPSDNCT05777551

AF Ablation With High Power Short Duration RF

An observational study of Atrial Fibrillation and Catheter Ablation, run by Clinica Mediterranea at 9 sites in 3 countries.

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

This is a prospective, multi-center, research study designed to evaluate the safety and efficacy of pulmonary vein (PV) isolation with high power short duration radiofrequency energy in patients with paroxysmal/persistent atrial fibrillation (AF). Read more about this study

Who is it for?
Ages 18 to 80 years
Conditions the study is for
Atrial Fibrillation, Catheter Ablation
How many people
850 participants
Where
9 sitesin 3 countries
Study dates
1 Jan 2023to 31 Dec 2027
How long will I take part?
12 Months
Phase
Observational
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 80 years
  • All sexes
  • Adult, Older adult

Study population: Patients with paroxysmal/persistent AF with indication to catheter ablation according to current guidelines

Who may be able to join

  • Patients with paroxysmal/persistent AF who signed the informed consent
  • Patients on active oral anticoagulation

Who cannot join

  • Previous ablation for AF
  • Patients with LVEF<35%
  • Women potentially pregnant
  • Contraindications to X-ray exposure
  • Congenital heart disease or cardiac surgery within 1 month

Trial locations and contacts

9 sites in 3 countries. Contact the study team or a site near you to ask about taking part.

Giuseppe Stabile, MD contact

+393488960534

gmrstabile@tin.it

Teresa Strisciuglio, MD contact

+393293238130

teresa.strisciuglio@unina.it

9 sites in 3 countries

Italy7 sites, 7 recruiting
  • Università Politecnica delle Marche

    Ancona

    Michela Casella

    Antonio Dello Russo

    Recruiting
  • Ospedale Civile di Asti

    Asti

    Marco Scaglione

    Recruiting
  • Ospedale di Conegliano

    Conegliano, TV

    Roberto Mantovan, MD

    Recruiting
  • Maria cecilia Hospital

    Cotignola, RA

    Saverio Iacopino

    Recruiting
  • Clinica Montevergine

    Mercogliano, AV

    Francesco Solimene

    Recruiting
  • Clinica Mediterranea

    Naples, 80100

    Giuseppe Stabile

    Recruiting
  • Città della Salute e della Scienza di Torino, Dipartimento di Scienze Mediche della Università di Torino.

    Torino

    Matteo Anselmino

    Not yet recruiting

Other trials in Italy

France1 site, 1 recruiting
  • Centre Cardiologique Du Nord

    Paris

    Antoine Lepillier

    Recruiting

Other trials in France

United Kingdom1 site, 1 recruiting
  • Royal Papworth Hospital

    Cambridge

    Claire Martin

    Not yet recruiting

Other trials in United Kingdom

About this study

Official title: Atrial Fibrillation Ablation by Means of Very High Power Short Duration (AIR HPSD Registry)

This is a prospective, multi-center, research study designed to evaluate the safety and efficacy of pulmonary vein (PV) isolation with high power short duration radiofrequency energy in patients with paroxysmal/persistent atrial fibrillation (AF).

Subjects with paroxysmal/persistent AF will undergo catheter ablation using commercially approved devices (mapping system and catheters).

Read more

Patients will be followed up for 12 months to measure the recurrence of AF and its predictors. The primary endpoint will be to investigate the association between clinical and procedural characteristics and the efficacy and the safety of PVI performed with HPSD.

At least 850 consecutive will be enrolled to have an adequate statistical power for the analysis of the primary endpoint. We assume that the freedom form AF recurrence at 12 months will be 80%. Expected R^2 (Cox-Snell) 0.1. Candidate variables to be included in the model:10. Shrinkage level: 0.9. Based on these assumption the minimum number of patients is 850 with 170 events and EPP 17.

Read the detailed description

Patients will be screened in ambulatory and scheduled for AF ablation according to current guidelines. Ablation will be usually performed under effective oral anticoagulation. Anticoagulation could be withdrawn before admission, so as antiarrhythmic drugs will be removed before scheduled procedure. Patients in AF or with a CHA2DS2-VASc score ≥ 1 will undergo transesophageal echocardiography within 48 hours prior to the ablation. For all other patients transesophageal echocardiography is optional. Cardiac MRI or Cardiac CT scan could be executed as a reference for volume estimations obtained with the mapping system.

Ablation will be carried out under mild or deep sedation, or general anesthesia according to center preference. At least 2 femoral vein access will be obtained and in some patients 1 subclavian vein. One diagnostic catheter will be positioned in the coronary sinus. One or two transseptal accesses to the left atrium will be achieved using a standard approach. Then, the mapping catheter (LASSO, Penta-ray, Octa-ray catheter) and the ablation catheter (QDot Micro catheter) will be placed in the left atrium. Heparin will be administered before the transseptal punctures to maintain an activated clotting time ≥ 300 seconds for the duration of the procedure. Left atrium mapping will be performed in sinus rhythm. Patients with atrial fibrillation at the beginning of the index procedure will undergo electrical cardioversion. After left atrium reconstruction the effective PV-left atrium electrical connection will be checked with the mapping catheter. In all patients a wide antrum circumferential ablation aimed at PV isolation will be performed using the QDot Micro catheter in QMode+ mode (90 w for 4 sec) for the whole ablation or in an hybrid mode (QMode + for posterior wall and QMode guided by AI in the anterior wall), according to the operator preference. The maximum interlesion distance will be <6 mm (16,17). According to operator preference it will be performed an ablation line encircling each PV or two ablation lines encircling the right and the left PVs. At the end of the ablation effective PV isolation (entry and exit block), will be checked with mapping catheter. After PV isolation will be achieved, the reconnection of the same vein will be evaluated after a 20 minute period from the initial isolation or after adenosine infusion or isoproterenol. If the vein reconnects to the atrium, the ablation will be directed to the gaps identified by the mapping catheter.

All patients will undergo a post-procedural ECG and, optional, an echocardiogram to exclude pericardial effusion or other acute complications.

After ablation, patients will undertake regular follow-up assessments (scheduled at 3 months) including a detailed history, physical examination, 12-lead standard electrocardiography, and 24-h Holter monitoring. Patients who will not report any symptoms related to the previous arrhythmia during a supplementary detailed follow up (6-12 months subsequent to catheter ablation) will be considered free of arrhythmia recurrence

Medical subject headings
Atrial Fibrillation

What is being measured

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

  1. Association between clinical and procedural characteristics and the percentage of arrhythmia recurrence rate after PV isolation performed with HPSD.

    to assess the efficacy of the procedure in terms of atrial arrhythmia recurrence-free rate (binary outcome), with a number of candidate predictors equal to 10

    Measured: 12 months after ablation

Secondary outcomes (7)
  1. Percentage of acute pulmonary vein reconnection reconnection

    After PV isolation will be achieved, the reconnection of the same vein will be evaluated after a 20 minute period from the initial isolation or after adenosine infusion or isoproterenol.

    Measured: 20 minutes after ablation

  2. Procedural time

    The Investigators will calculate the overall procedural time (min)

    Measured: during the procedure

  3. Percentage of patients with atrial arrhythmias recurrence during the blanking period

    Number of patients with an atrial arrhythmia (atrial fibrillation, atrial tachycardia, atrial flutter) episode lasting at least 30 sec during the 3 month blanking period after the index ablation

    Measured: 3 months after ablation

  4. Impact of anaesthesia type

    The Investigators will evaluate the type of anesthesia: (mild sedation, deep sedation, general anesthesia), the anesthetic drugs used and their dose in mg

    Measured: during the procedure

  5. Evaluation of pain perception during ablation

    The Investigators will assess the pain during the ablation with a 0-10 pain scale (0 no pain, 1-3 mild, 4-6 moderate, 7-9 severe, 10 very severe).

    Measured: during the procedure

  6. Fluoroscopy time

    The Investigators will calculate the overall fluoroscopy time (sec)

    Measured: during the procedure

  7. Radiofrequency time

    The Investigators will calculate the overall radiofrequency time (sec)

    Measured: during the procedure

Timeline

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

  1. First posted21 Mar 2023
  2. Study start1 Jan 2023
  3. Primary completion31 Dec 2026 (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
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
850 participants (estimated)
Target duration
12 Months
IDs, dates and publications
ClinicalTrials.gov ID
NCT05777551
Sponsor's protocol ID
AIR HPSD
Acronym
AIR HPSD
Status last verified
Mar 2024
First submitted
15 Feb 2023
Last updated
5 Mar 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: all collected IPD

Publications

  • Stabile G, Lepillier A, De Ruvo E, Scaglione M, Anselmino M, Sebag F, Pecora D, Gallagher M, Rillo M, Viola G, Rossi L, De Santis V, Landolina M, Castro A, Grimaldi M, Badenco N, Del Greco M, De Simone A, Pisano E, Abbey S, Lamberti F, Pani A, Zucchelli G, Sgarito G, Dugo D, Bertaglia E, Strisciuglio T, Solimene F. Reproducibility of pulmonary vein isolation guided by the ablation index: 1-year outcome of the AIR registry. J Cardiovasc Electrophysiol. 2020 Jul;31(7):1694-1701. doi: 10.1111/jce.14531. Epub 2020 May 11.

    PubMed 32369225
  • Duytschaever M, Vijgen J, De Potter T, Scherr D, Van Herendael H, Knecht S, Kobza R, Berte B, Sandgaard N, Albenque JP, Szeplaki G, Stevenhagen YJ, Taghji P, Wright M, Macours N, Gupta D. Standardized pulmonary vein isolation workflow to enclose veins with contiguous lesions: the multicentre VISTAX trial. Europace. 2020 Nov 1;22(11):1645-1652. doi: 10.1093/europace/euaa157.

    PubMed 32879974
  • Ouyang F, Antz M, Ernst S, Hachiya H, Mavrakis H, Deger FT, Schaumann A, Chun J, Falk P, Hennig D, Liu X, Bansch D, Kuck KH. Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double Lasso technique. Circulation. 2005 Jan 18;111(2):127-35. doi: 10.1161/01.CIR.0000151289.73085.36. Epub 2004 Dec 27.

    PubMed 15623542
  • Lemola K, Hall B, Cheung P, Good E, Han J, Tamirisa K, Chugh A, Bogun F, Pelosi F Jr, Morady F, Oral H. Mechanisms of recurrent atrial fibrillation after pulmonary vein isolation by segmental ostial ablation. Heart Rhythm. 2004 Jul;1(2):197-202. doi: 10.1016/j.hrthm.2004.03.071.

    PubMed 15851153
  • Cappato R, Negroni S, Pecora D, Bentivegna S, Lupo PP, Carolei A, Esposito C, Furlanello F, De Ambroggi L. Prospective assessment of late conduction recurrence across radiofrequency lesions producing electrical disconnection at the pulmonary vein ostium in patients with atrial fibrillation. Circulation. 2003 Sep 30;108(13):1599-604. doi: 10.1161/01.CIR.0000091081.19465.F1. Epub 2003 Sep 8.

    PubMed 12963643
  • Wang XH, Liu X, Sun YM, Gu JN, Shi HF, Zhou L, Hu W. Early identification and treatment of PV re-connections: role of observation time and impact on clinical results of atrial fibrillation ablation. Europace. 2007 Jul;9(7):481-6. doi: 10.1093/europace/eum101. Epub 2007 May 23.

    PubMed 17522081
  • McLellan AJ, Kumar S, Smith C, Morton JB, Kalman JM, Kistler PM. The role of adenosine following pulmonary vein isolation in patients undergoing catheter ablation for atrial fibrillation: a systematic review. J Cardiovasc Electrophysiol. 2013 Jul;24(7):742-51. doi: 10.1111/jce.12121. Epub 2013 Mar 14.

    PubMed 23489944
  • Leshem E, Zilberman I, Tschabrunn CM, Barkagan M, Contreras-Valdes FM, Govari A, Anter E. High-Power and Short-Duration Ablation for Pulmonary Vein Isolation: Biophysical Characterization. JACC Clin Electrophysiol. 2018 Apr;4(4):467-479. doi: 10.1016/j.jacep.2017.11.018. Epub 2018 Feb 2.

    PubMed 30067486
  • Barkagan M, Contreras-Valdes FM, Leshem E, Buxton AE, Nakagawa H, Anter E. High-power and short-duration ablation for pulmonary vein isolation: Safety, efficacy, and long-term durability. J Cardiovasc Electrophysiol. 2018 Sep;29(9):1287-1296. doi: 10.1111/jce.13651. Epub 2018 Jun 20.

    PubMed 29846987
  • Reddy VY, Grimaldi M, De Potter T, Vijgen JM, Bulava A, Duytschaever MF, Martinek M, Natale A, Knecht S, Neuzil P, Purerfellner H. Pulmonary Vein Isolation With Very High Power, Short Duration, Temperature-Controlled Lesions: The QDOT-FAST Trial. JACC Clin Electrophysiol. 2019 Jul;5(7):778-786. doi: 10.1016/j.jacep.2019.04.009. Epub 2019 May 8.

    PubMed 31320006
  • Stabile G, Schillaci V, Strisciuglio T, Arestia A, Agresta A, Shopova G, De Simone A, Solimene F. In vivo biophysical characterization of very high power, short duration, temperature-controlled lesions. Pacing Clin Electrophysiol. 2021 Oct;44(10):1717-1723. doi: 10.1111/pace.14358. Epub 2021 Sep 15.

    PubMed 34498748
  • Halbfass P, Wielandts JY, Knecht S, Le Polain de Waroux JB, Tavernier R, De Wilde V, Sonne K, Nentwich K, Ene E, Berkovitz A, Mueller J, Lehmkuhl L, Reichart A, Lusebrink U, Duytschaever M, Deneke T. Safety of very high-power short-duration radiofrequency ablation for pulmonary vein isolation: a two-centre report with emphasis on silent oesophageal injury. Europace. 2022 Mar 2;24(3):400-405. doi: 10.1093/europace/euab261.

    PubMed 34757432
  • Richard Tilz R, Sano M, Vogler J, Fink T, Saraei R, Sciacca V, Kirstein B, Phan HL, Hatahet S, Delgado Lopez L, Traub A, Eitel C, Schluter M, Kuck KH, Heeger CH. Very high-power short-duration temperature-controlled ablation versus conventional power-controlled ablation for pulmonary vein isolation: The fast and furious - AF study. Int J Cardiol Heart Vasc. 2021 Jul 26;35:100847. doi: 10.1016/j.ijcha.2021.100847. eCollection 2021 Aug.

    PubMed 34381869
  • Sallo Z, Perge P, Balogi B, Orban G, Piros K, Herczeg S, Nagy KV, Osztheimer I, Abraham P, Merkely B, Geller L, Szegedi N. Impact of High-Power and Very High-Power Short-Duration Radiofrequency Ablation on Procedure Characteristics and First-Pass Isolation During Pulmonary Vein Isolation. Front Cardiovasc Med. 2022 Jul 7;9:935705. doi: 10.3389/fcvm.2022.935705. eCollection 2022.

    PubMed 35872909
  • 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

Questions about this trial

What is this clinical trial studying?

An observational study of Atrial Fibrillation and Catheter Ablation, run by Clinica Mediterranea at 9 sites in 3 countries.

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 2 inclusion and 5 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 5 Mar 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 9 sites in Italy, France, United Kingdom. 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 Giuseppe Stabile, MD (+393488960534, gmrstabile@tin.it), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Association between clinical and procedural characteristics and the percentage of arrhythmia recurrence rate after PV isolation performed with HPSD. (time frame: 12 months after ablation). 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 NCT05777551, which also lists 17 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 5 Mar 2024.

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