The purpose of this study it to learn whether pulmonary vein isolation (PVI) along with isolation of the posterior left atrial wall (PWI) in the region of the pulmonary venous component will reduce the likelihood of atrial fibrillation (AF) recurrence in patients with persistent atrial fibrillation at 12 months, after a single ablation procedure, in comparison to PVI alone. The investigator hypothesizes that the combination of PVI + PWI will result in a significant reduction in recurrence of atrial fibrillation at 12 months after ablation.
Patients with persistent atrial fibrillation will be enrolled in this multi-center, randomized, prospective, single-blinded study. After catheter ablation (isolation) of the pulmonary veins (PVI) and while still in the cardiac electrophysiology laboratory, all patients will be randomized to either PVI alone or the combination of PVI + posterior left atrial wall isolation (PWI). For patients randomized to PVI, their ablation procedure will be completed at that time. For those patients randomized to PVI + PWI, they will have additional ablation to achieve PWI. All study patients will have the same follow-up after their ablation procedure, including clinic visits at 3, 6, and 12 months and a heart event monitor for 7-14 days before these visits. An echocardiogram (heart ultrasound) is performed at 6 to 12 months after the ablation. Blood thinners are recommended for two months after ablation and then the need for continued use of blood thinners will be based on individual patient's medical history, stroke risk and the decision of the study doctor. Information about the patients' medical history, heart arrhythmias and atrial fibrillation will be collected during the study which will be analyzed.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
153
Arctic Front Advance cryoballoon ablation system to ablate the pulmonary veins to achieve PVI alone
Arctic Front Advance Cardiac Cryoballoon Ablation System to ablate the pulmonary veins and the left atrial posterior wall to achieve PVI + posterior wall isolation within the region of the pulmonary venous component
Mercy General Hospital and Dignity Health Medical Foundation
Sacramento, California, United States
UCHealth Medical Center
Fort Collins, Colorado, United States
MedStar Georgetown University Hospital and Medical Center
Washington D.C., District of Columbia, United States
12-month freedom from recurrent atrial fibrillation
Number of participants with recurrent atrial fibrillation following catheter ablation
Time frame: 12 months
All atrial arrhythmia recurrences
Number of atrial arrhythmia recurrences after the 90-day blanking period
Time frame: During a follow-up period of 12 months
Change in Canadian Cardiovascular Society Severity of Atrial Fibrillation Scale (CCS-SAF)
Change in CCS-SAF from baseline to 12 months
Time frame: During a follow-up period of 12 months
Change in Atrial Fibrillation Effect on Quality of Life Questionnaire (AFEQT)
Change in AFEQT from baseline to 12 months
Time frame: During a follow-up period of 12 months
Multiple procedure success
Absence of recurrent atrial arrhythmias after one or more ablation procedure(s)
Time frame: During a follow-up period of 12 months
Relative reduction in atrial fibrillation burden
Reduction in the burden of atrial fibrillation (in percentage) following catheter ablation
Time frame: During a follow-up period of 12 months
Freedom from cardioversion for recurrent atrial arrhythmias
Electrical or pharmacological cardioversion for treatment of recurrent atrial arrhythmias not required
Time frame: During a follow-up period of 12 months
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Sarasota Memorial Health Care System
Sarasota, Florida, United States
Tampa Cardiac Specialists
Tampa, Florida, United States
Brigham and Women's Hospital
Boston, Massachusetts, United States
Beth Israel Deaconess Medical Center
Boston, Massachusetts, United States
Nebraska Methodist Hospital-Methodist Physicians Clinic
Omaha, Nebraska, United States
Bethesda North Hospital
Cincinnati, Ohio, United States
St. Luke's University Health Network
Bethlehem, Pennsylvania, United States
...and 1 more locations
Freedom from repeat atrial fibrillation ablation
Repeat ablation for atrial fibrillation
Time frame: During a follow-up period of 12 months
Left Atrial Diameter (Size) as predictor of atrial fibrillation recurrence
Change in left atrial diameter (in millimeters) following ablation
Time frame: During a follow-up period of 12 months
Left Ventricular Ejection Fraction as predictor of atrial fibrillation recurrence
Change in left atrial ejection fraction (in percentage) following ablation
Time frame: During a follow-up period of 12 months
New York Heart Association Functional Class as predictor of atrial fibrillation recurrence
Change in New York Heart Association Functional Class following ablation
Time frame: During a follow-up period of 12 months