Atrial fibrillation (AF) is a common but often distressing condition. It can be treated with medications, but these are not always effective or tolerated. Ablation is a well-recognised technique that is recommended for those with symptomatic AF who have failed medical therapy. Ablation can be performed in a number of ways. In percutaneous ablation, ablation is performed via tiny punctures in the skin in the groin. In minimally-invasive thoracoscopic ablation, ablation is performed under general anaesthetic via very small incisions in the chest wall. Because AF can be intermittent, the only reliable way to look for it is with long-term ECG monitoring. A safe and practical way to do this is to use implantable loop recorders (ILRs). In this study, the investigators are trying to see if minimally-invasive thoracoscopic ablation is better than percutaneous ablation, and in turn if they are better than Direct current cardioversion (DCCV), using ILRs to monitor AF.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
An implantable loop recorder (ILR) will be used to assess atrial fibrillation(AF) before and after DCCV or ablation, unless there is a pre-existing ILR or permanent pacemaker capable of continuous monitoring for occurrence of AF.
Catheter-based percutaneous ablation of atrial fibrillation
Minimally-invasive thoracoscopic surgical ablation of atrial fibrillation
Royal Sussex County Hospital
Brighton, East Sussex, United Kingdom
Eastbourne District General Hospital
Eastbourne, East Sussex, United Kingdom
Reduction in AF burden after ablation
Reduction in proportion of time in atrial fibrillation as detected by an implantable loop recorder
Time frame: One year
Time to recurrence of persistent AF
Time frame: 1 year
Time to recurrence of atrial fibrillation after ablation
Time to first detected episode of atrial fibrillation after ablation, outside a 3 month blanking period
Time frame: One year
Time to recurrence of symptomatic atrial fibrillation after ablation
Time to first detected symptomatic episode of atrial fibrillation after ablation, outside a 3 month blanking period
Time frame: One year
New MRI-detected subclinical cerebral ischaemia
Time frame: 1 year
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