Ectopy Triggering Ganglionated Plexus Ablation to Prevent Atrial Fibrillation

Not Applicable

Completed

Interventions: Procedure: Pulmonary vein isolation
Procedure: Ganglionated plexus ablation

Brief Summary: Atrial fibrillation (AF) is a common heart rhythm disorder which can significantly affect a patient's quality of life and cause strokes. Abnormal electrical activity from the pulmonary veins are thought to be the most common cause of this condition. Current ablative strategy in drug refractory AF is pulmonary vein isolation (PVI), where the pulmonary veins are electrically isolated from the body of the left atrium. However, success rate of this procedure remain \~50-70% for a single procedure despite advances in mapping and ablation techniques.

Ganglionated plexuses (GP) are dense clusters of nerves in the atria that are implicated in AF. Endocardial high frequency stimulation (HFS) delivered within the local atrial refractory period can trigger ectopy and AF from specific GP sites (ET-GP). The aim of this study was to understand the role of ET-GP ablation in the treatment of AF by comparing two different strategies:

1. Pulmonary vein isolation alone

2. GP ablation alone

Detailed Description: This is a prospective, multi-centre study recruiting patients with paroxysmal AF indicated for AF ablation.

180 patients will be recruited. Patients are randomised to either GP ablation alone or to PVI. All antiarrhythmics are stopped for at least 48 hours prior to their procedures.

All have general anaesthesia and CARTO system (Biosense Webster, inc.) are used for 3D electroanatomical mapping of the left atrium.

Patients randomised to GP ablation will have high frequency mapping performed within the atrial refractory period to identify ectopy or AF triggering GP (ET-GP) sites in the left atrium. Patients in this group will only have GP ablation and will not have pulmonary veins isolated.

The primary endpoint is any documented atrial arrhythmia 30 seconds or more after a 3 month blanking period. This will be assessed for up to 12 months post-procedure, using 48hr Holter monitors at 3, 6, 9 and 12 month intervals.

Secondary endpoints include mortality, major complications and redo procedures.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Contraindication to catheter ablation
Presence of a cardiac thrombus
valvular disease that is grade moderate or greater
Any form of cardiomyopathy
On amiodarone therapy
Severe cerebrovascular disease
Active gastrointestinal bleeding
Renal failure (on dialysis or at risk of requiring dialysis)
Active infection or fever
Life expectancy shorter than the duration of the trial
Allergy to contrast
Intractable heart failure (NYHA Class IV)
Bleeding or clotting disorders or inability to receive heparin
Serum Creatinine >200umol/L
Uncontrolled diabetes (HbA1c ≥73mmol/mol or HbA1c ≤64mmol/mol and Fasting Blood Glucose ≥9.2mmol/L)
Malignancy needing therapy
Pregnancy or women of childbearing potential not using a highly effective method of contraception
Patients in current research or have recently been involved in any research prior to recruitment will not be included in the trial.

Arm && Interventions

Group	Intervention	Description
Pulmonary vein isolation	Pulmonary vein isolation	Conventional endocardial radiofrequency catheter ablation for pulmonary vein isolation.
Ganglionated plexus ablation	Ganglionated plexus ablation	Endocardial radiofrequency catheter ablation of ganglionated plexus in the left atrium

Primary Outcome Measures

Name	Time	Method
Number of Patients With no Evidence of >30s Recurrent Atrial Arrhythmia Post-index Procedure	3 to 12 months post-ablation.	That is documented recurrent atrial arrhythmia lasting 30 seconds or more after a blanking period of 3 months; the outcome measure will be assessed up to 12 months of follow-up with 48hr halter monitors arranged every 3 months to investigate Arrhythmia recurrence .

Secondary Outcome Measures

Name	Time	Method
Number of Participants Presenting a Reduction in the Usage of Antiarrhythmics Post-ablation	3 to 12 months post-ablation.	The reduction was defined as either a decrease of dose or a cessation of a drug over a 12 month follow-up period post ablation.

Locations (3): Derriford Hospital
🇬🇧
Plymouth, United Kingdom
St Bartholomew's Hospital
🇬🇧
London, United Kingdom
Hammersmith Hospital
🇬🇧
London, United Kingdom

Receive instant email notifications about changes in this clinical trial

Receive instant email notifications about changes in this clinical trial