Pulsed Field Ablation Versus Conventional Radiofrequency Catheter Ablation for Repeat PVI in Patients With Paroxysmal AF — REPEAT-AF  

Atrial Fibrillation Recurrent Clinical Trial

Official title: Pulsed Field Ablation Versus Conventional Radiofrequency Catheter Ablation for Repeat

Status Not yet recruiting

Clinical Trial Summary

Various methods exist for performing pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF), including thermal ablation and pulse-field ablation (PFA). However, in cases requiring a second PVI for recurrent AF, radiofrequency ablation (RFA) is utilized in nearly 95% of instances post-acquiring a 3D high-density map from the left atrium (LA). Up to 85% of patients experiencing recurrent AF after the initial PVI exhibit pulmonary vein (PV) reconnections, often identified as the cause of AF.

PFA has demonstrated its safety and efficiency compared to RFA as a swift technique for performing ablation. Yet, whether PFA or RFA stands out as superior or safer when applied for a second PVI remains unclear, as no randomized controlled trial has investigated this comparison. The proposed REPEAT-AF trial aims to randomize 154 AF patients experiencing recurrent AF after the initial PVI, assigning them in a 1:1 ratio to either RFA or PFA. Each patient will receive an implantable cardiac monitor to precisely detect any AF recurrences.

Clinical Trial Description

This study involves assessing suitable patients through (a) review of the patient's medical/surgical history, (b) assessment of concomitant medications, (c) documentation of AF recurrence ≥30 seconds, (d) transthoracic echocardiogram (≤6 months prior), and (e) an evaluation by the treating cardiac electrophysiologist to confirm eligibility for repeat PVI. Qualified screened patients are eligible for study enrolment.

All participating patients are required to provide written (or equivalent) informed consent, indicated by a dated signature of the subject or legal representative. The consent process must comply with applicable national regulations and use language understandable by the patient.

The study will be conducted at 6 clinical centres/investigational sites across the Netherlands. Patients will be randomized (1:1) into a PFA or point-by-point RF ablation arm. Randomization will occur prior to the ablation procedure. A implantable cardiac monitor will be implanted in all randomised patients one month before ablation to accurately monitor any AF/atrial flutter (AFL)/ atrial tachycardia (AT) recurrence. Treatment allocation will be processed through the Dutch 'National Heart Registry' (NHR) data platform.

Patients randomized to both arms of the study will be evaluated for PV isolation at the start of the ablation procedure. If PV reconnection is identified in patients in the point-by-point RF arm, re-ablation will occur according to the study protocol. Patients in the PFA arm will have PV reconnection determined using the FARAWAVE catheter. Those with no PV reconnection (100% PV isolation/durable PVI) will be followed in an observational registry.

The PFA ablation arm involves the use of the Farastar generator system, Farawave ablation catheter, and Faradrive steering catheter for the procedure. The RF point-by-point ablation arm (control) involves RF ablation following standard practice.

Patients will be closely monitored during the study for any adverse effects or procedure-related complications. ;

Related Conditions & MeSH terms

• Atrial Fibrillation
• Atrial Fibrillation Recurrent

• NCT number: NCT06199180
• Study type: Interventional
• Source: University Medical Center Groningen
• Contact: Yuri Blaauw, Dr.
• Phone: +31503616161
• Email: y.blaauw01@umcg.nl
• Status: Not yet recruiting
• Phase: N/A
• Start date: July 2024
• Completion date: July 2028