Ablating Atrial Tachycardias Occuring During Ablation of Complex Fractionated Electrograms in Persistent AF (ATTAC CFAE)

German Heart Center Munich

Status: Completed

Conditions: Atrial Flutter; Atrial Fibrillation; Ablation

Treatments: Procedure: Ablation; Procedure: Cardioversion

Study type: Interventional

Funder types: Other

Identifiers

NCT01229033

GER-EP-001

Details and patient eligibility

About

Catheter ablation has proven to be an effective treatment option in patients suffering from symptomatic persistent atrial fibrillation (AF). Catheter ablation consists of two major steps: (1) Isolation of pulmonary veins to abolish the trigger of atrial fibrillation and (2) modification of left atrial and eventually right atrial substrate by ablation of complex fractionated atrial electrograms (CFAE). CFAE are mainly found at the ostia of the pulmonary veins, around the left atrial appendage, at the mitral annulus and the septum.

When ablating CFAE 40-65% of the patients show a regularization of AF to an atrial tachycardia (AT) that can be macro- or micro-reentrant (localized re-entry). Until now the significance of the AT is unclear.

In the following study we examine the hypothesis that an ablation of AT occuring during CFAE ablation (group 1) significantly improves outcome defined as freedom of atrial arrhythmia (AF or AT) compared to patients that are cardioverted when AF has regularized to AT (group 2).

Enrollment: 186 estimated patients

Sex: All

Ages: 18 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients (>=18 und < 80 years) with symptomatic persistent AF (AF episode enduring at least 7 days) but are successfully convertable in sinus rhythm (SR).
• At least one unsuccessful attempt of antiarrhythmic drug (betablocker or class I oder III).
• Oral anticoagulation with phenprocoumone or warfarine for at least 4 weeks prior to ablation with weekly documented INR > 2..
• Withdrawal of antiarrhythmic drugs at least 3 half times prior to ablation except amiodarone.
• Atrial tachycardia occurring during ablation of CFAE (defined as CL > 200 msec und stable activation sequence).

Exclusion criteria

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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186 participants in 2 patient groups

Ablation

Active Comparator group

Description:

Ablation of atrial tachycardia

Treatment:

Procedure: Ablation

Cardioversion

Active Comparator group

Description:

Cardioversion of atrial tachycardia

Treatment:

Procedure: Cardioversion