Posterior Wall Substrate Modification Using Irreversible Electroporation for Paroxysmal Atrial Fibrillation

Jorge Romero198 enrolled

Overview

The purpose of this study is to compare the efficacy and safety between pulmonary vein isolation (PVI) alone versus PVI with left atrial (LA) posterior wall isolation (PWI) using pulsed-field ablation (PFA) in the treatment of patients with paroxysmal atrial fibrillation (PAF).

This is an investigator-initiated, prospective, randomized, multi-center, Investigational Device Exemption (IDE) study. Subjects undergoing first-time ablation for paroxysmal atrial fibrillation will be randomized to receive either pulmonary vein isolation (PVI) alone or PVI combined with posterior wall isolation (PWI) using pulsed field ablation (PFA) with the FARAWAVE PFA catheter. Following the index procedure, all participants will enter a 3-month blanking period, during which they will be closely monitored. After this period, anti-arrhythmic drug (AAD) therapy will be discontinued for all patients. Throughout the entire study, patients will be monitored using an implantable loop recorder (ILR) to assess the primary outcome of efficacy. The study includes a 12-month follow-up period, and the primary objective is to assess and compare the efficacy, defined as an improvement in freedom from all-atrial arrhythmias, and safety, defined as the occurrence of all procedure-related complications.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

198

Conditions

Atrial Fibrillation Paroxysmal

Interventions

Farapulse PFA, Pulmonary Vein Isolation aloneDEVICE

Ablation of the pulmonary veins for the treatment of Paroxysmal Atrial Fibrillation using pulsed field ablation.

Farapulse PFA, Pulmonary Vein Isolation and Left atrial Posterior Wall IsolationDEVICE

Ablation of the pulmonary veins and the left atrium posterior wall for the treatment of Paroxysmal Atrial Fibrillation using pulsed field ablation.

Eligibility

Sex: ALLMin age: 21 YearsMax age: 90 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Provision of signed and dated informed consent form. 2. Stated willingness to comply with all study procedures and availability for the duration of the study. 3. Age 21-90 years. 4. Symptomatic PAF whether failed AAD or not. 5. At least one symptomatic episode of PAF lasting \<7 days, documented on electrocardiogram (ECG), Holter, ZioPatch, ILR, or smartwatch recording in the year prior to enrollment. 6. Patients undergoing first time ablation for AF. 7. Subject has any commercially available implantable loop recorder (ILR) or agrees to have one implanted prior or during the ablation procedure. Exclusion Criteria: 1. Persistent atrial fibrillation (PeAF) (\> 7 days in duration). 2. Atrial arrhythmias secondary to electrolyte imbalance, thyroid disease, or other reversible non-cardiac cause. 3. Previous surgical or catheter ablation of AF. 4. Previous valve surgery, ventriculotomy, atriotomy, or presence of a mitral mechanical prosthetic or bioprosthetic valve. 5. Left atrium anteroposterior (LA AP) diameter \>55 mm or indexed left atrium (LA) volume \>48 ml/m2. 6. Contraindications to oral or systemic anticoagulation. 7. Previous thromboembolic event (including ischemic strokes and TIA) within the last 3 months. 8. Previous myocardial infarction or percutaneous coronary intervention within the past 2 months. 9. Coronary Artery Bypass Grafting (CABG) surgery within the past 6 months (180 days). 10. Pregnancy. 11. History of PV stenosis. 12. History of severe pulmonary hypertension. 13. History of diaphragmatic paresis or hemi-paresis. 14. History of heart transplantation. 15. History of blood clotting or bleeding abnormalities. 16. Life expectancy of less than 12 months. 17. Presence of intracardiac thrombus. 18. Complex congenital heart disease, including tetralogy of Fallot, ventricular septal defects, Ebstein's anomaly, systemic right ventricle, and transposition of the great arteries. 19. Intracardiac or vascular abnormalities that preclude adequate catheter introduction or manipulation within the LA. 20. Pacing dependent patients. 21. Active malignancy or history of treated malignancy within 12 months of enrollment (other than cutaneous basal cell or squamous cell carcinoma). 22. Active systemic infection. 23. Participation in any other AF-related randomized clinical trial.

Locations (18)

Grandview Medical Center

Birmingham, Alabama, United States

MedStar Washington Hospital Center

Washington D.C., District of Columbia, United States

Outcomes

Primary Outcomes

Procedural success, defined as freedom from of all documented atrial arrhythmias episodes after the 3-month blanking period.

will be assessed by: * Occurrence of all atrial arrhythmias after the 3-month blanking period. * Any cardioversion for atrial fibrillation (AF), atrial flutter (AFL), or atrial tachycardia (AT) after the 3-month blanking period. * Use of any type I or type III antiarrhythmic medication for the treatment of AF, AFL, or AT after the 3-month blanking period, or the use of amiodarone at any time. * Re-ablation of AF, AFL, or AT.

Time frame: 12 months

The primary safety endpoint is a composite of acute procedure-related complications and any other major adverse events within the 12 months following the ablation procedure.

All number of acute procedure-related complications will be reported and assessed including: atrio-esophageal fistula, cardiac perforation, pulmonary vein (PV) stenosis, acute kidney injury, phrenic nerve paralysis, thromboembolic events, stroke, or transient ischemic attacks (TIA), and other major adverse events within the 12 months following the ablation procedure: pericarditis cardiac tamponade pericardial effusion, coronary artery spasm, Vascular access complication/major bleeding, local hematoma, ecchymosis left atrium or vascular laceration

Time frame: 12 Months

Secondary Outcomes

Freedom from atrial arrhythmias medication

Time and dose of anti arrhythmic medications use will be compared between the two groups.

Time frame: 12 Months

Procedural time

procedural time will be compared among groups.

Time frame: 12 Months

Procedure-related Recurrencies

Rate of PV and PW reconnection in patients undergoing repeat ablation procedures for recurrence of AF.

Time frame: 12 Months

Data from ClinicalTrials.gov

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