Predictive Factors for Successful Outcome After Pulmonary Veins Ablation to Treat Paroxysmal Atrial Fibrillation

Atrial Fibrillation Clinical Trial

Official title:

A Single-center, Observational, 12-months Study to Examine the Predictive Factors for Successful Outcome After Pulmonary Veins Ablation to Treat Patients With Paroxysmal Atrial Fibrillation.

Clinical Trial Details — Status: Withdrawn

Administrative data

• NCT number: NCT02614521
• Other study ID #: 2015-IIS-GR-AF
• Status: Withdrawn
• Start date: January 2017
• Est. completion date: February 2019

Study information

• Verified date: December 2018
• Source: Elpen Pharmaceutical Co. Inc.
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

Atrial fibrillation is the most common serious abnormal heart rhythm affecting about 2% to 3% of the population, being associated with a 1.5- to 1.9-fold higher risk of death. Patients with paroxysmal AF in whom antiarrhythmic drug therapy does not elicit a response are potential candidates for RF ablation of AF. The success rate of RF ablation in the treatment of AF varies depending on the type and duration of AF (ie, paroxysmal vs persistent), structural remodeling of the heart, co-morbidities and the technique of the cardiac electrophysiologist, but it usually ranges from 60-80% over 1-2 years of follow-up.

To study and predict the successful outcome of RF ablation is of great clinical importance. Moreover, the detection of predictive factors for successful outcome may alter the therapeutic strategy determining a subgroup of patients in the need of more invasive management.

Description:

The study will include 150 patients scheduled to undergo pulmonary vein (PV) ablation because of non-responsive to medical therapy PAF. ECG recordings will be obtained during sinus rhythm before and after PV ablation with a 3 - channel digital recorder for 10 minutes, and digitized with a 16-bit accuracy at a sampling rate of 1000 Hz. The P wave will be analyzed using the Morlet wavelet. Other parameters to be analyzed include 12 lead surface ECG, the burden of main and secondary morphologies and echocardiographic indexes of left atrial mechanical function. Follow-up visits will be held in 3, 6 and 12 months after the ablation procedure.

Recruitment information / eligibility

• Status: Withdrawn
• Enrollment: 0
• Est. completion date: February 2019
• Est. primary completion date: February 2019
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 90 Years

Eligibility

Inclusion Criteria:

• Males and Females

• Age >18 years

• Paroxysmal AF (PAF) scheduled to undergo pulmonary vein (PV) ablation

• Singed written consent form

• Patients who will comply with study procedures

Exclusion Criteria:

• Age <18 years Permanent atrial fibrillation

• Acute myocardial infraction, coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty within less than 2 months prior to ablation procedure

• Life expectancy less than 12 months, according to investigator's judgment

• Participation to other clinical trial

• Patients who will not be compliant with study procedures

Related Conditions & MeSH terms

• Atrial Fibrillation

Intervention

Other:
• pulmonary veins ablation's successful outcome
Assessment of predictive factors in patients with successful outcome of pulmonary veins ablations and suffer from paroxysmal atrial fibrillation.

Locations

Country	Name	City	State
Greece	Hippokrateion University Hospital	Thessaloniki

Sponsors (1)

Lead Sponsor	Collaborator
Elpen Pharmaceutical Co. Inc.

Country where clinical trial is conducted

Greece, 

References & Publications (15)

Blanche C, Tran N, Rigamonti F, Burri H, Zimmermann M. Value of P-wave signal averaging to predict atrial fibrillation recurrences after pulmonary vein isolation. Europace. 2013 Feb;15(2):198-204. doi: 10.1093/europace/eus251. Epub 2012 Aug 31. — View Citation

Byrd GD, Prasad SM, Ripplinger CM, Cassilly TR, Schuessler RB, Boineau JP, Damiano RJ Jr. Importance of geometry and refractory period in sustaining atrial fibrillation: testing the critical mass hypothesis. Circulation. 2005 Aug 30;112(9 Suppl):I7-13. — View Citation

Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, Hindricks G, Kirchhof P; ESC Committee for Practice Guidelines (CPG). 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J. 2012 Nov;33(21):2719-47. doi: 10.1093/eurheartj/ehs253. Epub 2012 Aug 24. Erratum in: Eur Heart J. 2013 Mar;34(10):790. Eur Heart J. 2013 Sep;34(36):2850-1. — View Citation

Ketels S, Houben R, Van Beeumen K, Tavernier R, Duytschaever M. Incidence, timing, and characteristics of acute changes in heart rate during ongoing circumferential pulmonary vein isolation. Europace. 2008 Dec;10(12):1406-14. doi: 10.1093/europace/eun287. Epub 2008 Oct 19. — View Citation

Liu X, Long D, Dong J, Hu F, Yu R, Tang R, Fang D, Hao P, Lu C, Liu X, He X, Liu X, Ma C. Is circumferential pulmonary vein isolation preferable to stepwise segmental pulmonary vein isolation for patients with paroxysmal atrial fibrillation? Circ J. 2006 Nov;70(11):1392-7. — View Citation

Martínez A, Alcaraz R, Rieta JJ. Application of the phasor transform for automatic delineation of single-lead ECG fiducial points. Physiol Meas. 2010 Nov;31(11):1467-85. doi: 10.1088/0967-3334/31/11/005. Epub 2010 Sep 24. — View Citation

Morlet D, Peyrin F, Desseigne P, Touboul P, Rubel P. Wavelet analysis of high-resolution signal-averaged ECGs in postinfarction patients. J Electrocardiol. 1993 Oct;26(4):311-20. — View Citation

Oral H. Mechanisms of atrial fibrillation: lessons from studies in patients. Prog Cardiovasc Dis. 2005 Jul-Aug;48(1):29-40. Review. — View Citation

Ouyang F, Antz M, Ernst S, Hachiya H, Mavrakis H, Deger FT, Schaumann A, Chun J, Falk P, Hennig D, Liu X, Bänsch 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. Epub 2004 Dec 27. — View Citation

Packer DL, Kowal RC, Wheelan KR, Irwin JM, Champagne J, Guerra PG, Dubuc M, Reddy V, Nelson L, Holcomb RG, Lehmann JW, Ruskin JN; STOP AF Cryoablation Investigators. Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal trial. J Am Coll Cardiol. 2013 Apr 23;61(16):1713-23. doi: 10.1016/j.jacc.2012.11.064. Epub 2013 Mar 21. — View Citation

Pappone C, Rosanio S, Oreto G, Tocchi M, Gugliotta F, Vicedomini G, Salvati A, Dicandia C, Mazzone P, Santinelli V, Gulletta S, Chierchia S. Circumferential radiofrequency ablation of pulmonary vein ostia: A new anatomic approach for curing atrial fibrillation. Circulation. 2000 Nov 21;102(21):2619-28. — View Citation

Pappone C, Santinelli V, Manguso F, Vicedomini G, Gugliotta F, Augello G, Mazzone P, Tortoriello V, Landoni G, Zangrillo A, Lang C, Tomita T, Mesas C, Mastella E, Alfieri O. Pulmonary vein denervation enhances long-term benefit after circumferential ablation for paroxysmal atrial fibrillation. Circulation. 2004 Jan 27;109(3):327-34. Epub 2004 Jan 5. — View Citation

Van Beeumen K, Houben R, Tavernier R, Ketels S, Duytschaever M. Changes in P-wave area and P-wave duration after circumferential pulmonary vein isolation. Europace. 2010 Jun;12(6):798-804. doi: 10.1093/europace/eup410. Epub 2010 Jan 3. — View Citation

Vassilikos V, Dakos G, Chatzizisis YS, Chouvarda I, Karvounis C, Maynard C, Maglaveras N, Paraskevaidis S, Stavropoulos G, Styliadis CI, Mochlas S, Styliadis I. Novel non-invasive P wave analysis for the prediction of paroxysmal atrial fibrillation recurrences in patients without structural heart disease: a prospective pilot study. Int J Cardiol. 2011 Dec 1;153(2):165-72. doi: 10.1016/j.ijcard.2010.08.029. Epub 2010 Sep 15. — View Citation

Xia Y, Hertervig E, Kongstad O, Ljungström E, Platonov P, Holm M, Olsson B, Yuan S. Deterioration of interatrial conduction in patients with paroxysmal atrial fibrillation: electroanatomic mapping of the right atrium and coronary sinus. Heart Rhythm. 2004 Nov;1(5):548-53. Erratum in: Heart Rhythm. 2005 Dec;2(12):1395. Pyotr, Platonov [corrected to Platonov, Pyotr]. — View Citation

* Note: There are 15 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Number of Paroxysmal Atrial Fibrillation (PAF) relapse(s)	Primary end point is one or more PAF relapse(s) during a period of 12 months after the ablation procedure.	12 months
Secondary	Number of Adverse Events	Adverse Events occurred during study period	12 months