Improved Procedural Workflow For Catheter Ablation Of Paroxysmal AF With High Density Mapping System And Advanced Technology

Overview

DELETE AF is a prospective, multicenter, non-randomized post-market study. All patients will be treated according to the standard care followed by each center. The protocol requires enrollment of consecutive patients from each center, according to eligibility criteria. During the 12 months follow-up period, clinical atrial fibrillation recurrence, occurrence of all kind of atrial arrhythmias and of all Adverse Events in the study population will be collected. The purpose of this study is to demonstrate a low rate of clinical atrial arrhythmias recurrence with an improved procedural workflow for catheter ablation of paroxysmal AF, using the most advanced point-by-point RF ablation technology in a multicenter setting. The primary objective of the study is the rate of success at the medium-long term follow-up after PVI in a population of consecutive patients undergoing paroxysmal AF ablation. The success of the ablation is defined in terms of percentage of patients free from any clinical atrial arrhythmia at a 12-month follow-up from the procedure.

Catheter ablation has been shown to be better than antiarrhythmic drug therapy in preventing clinical recurrences of atrial fibrillation (AF) and has emerged as an important therapeutic option for treating symptomatic drug-refractory, paroxysmal AF, with a Class I level A recommendation in ESC and ACC/AHA guidelines. Improvements in ablation technologies and techniques to safely create more durable lesions and could improve the risk- benefit profile of this procedure. Recent advances in RF catheter design include models with real-time monitoring of catheter-to-tissue contact force. Evidence suggests improved clinical success in paroxysmal AF ablation with stable catheter-tissue contact. In addition, advances in diagnostic catheter manufacturing techniques have improved tissue contact and reduced interelectrode distances, allowing multipoint recording with high spatial resolution and improved signal fidelity. These algorithmic improvements have improved the signal-to-noise ratio and automated the validation of cardiac signals. Novel insights from this revolutionary ultra-high density (UHD) mapping with rapid acquisition of thousands of activation points deepened physiological and pathophysiological understanding of cardiac electrophysiology and arrhythmogenesis. This includes the cardiac conduction system itself and more importantly, due to the number of affected patients, the healthy and diseased working myocardium. In that sense HDM-based targeted ablation, in conjunction with pacing manoeuvres can be helpful to avoid excessive ablation. Moreover, HDM has also been found to allow greater precision in the identification of reconnection gaps in pulmonary veins, therefore, targeted ablation resulted in lower radiofrequency time for PVI. The technological advances present great opportunities for improving the electroanatomic characterization of low-voltage activity in tissue such as the PV antra, likely representing vulnerabilities in antral lesion sets, and ablation of these targets seems to improve freedom from AF The primary objective of the study is the rate of success at the medium-long term follow-up after PVI in consecutive patients undergoing atrial fibrillation ablation. The success of the ablation is defined in terms of percentage of patients free from any clinical atrial arrhythmia at a 12-month follow-up from the procedure. Secondary objectives of the study are: evaluation of acute procedural success, correlation between acute success and medium- long-term success, evaluation of the proportion of patients who will be asymptomatic during follow-up, patient reported outcomes, rate of clinical atrial fibrillation recurrence during follow up, rate of occurrence of other arrhythmias during follow-up, association between occurrence of atrial arrhythmias and baseline patient's characteristics (clinical history and drug therapy) or procedural data (post-hoc voltage and activation maps analysis), estimation of costs associated with the use of health care resources, rate of the adverse events associated with the primary ablation procedure and overall procedure time.