Correlation of the Arrhythmia Mechanism and Substrate to Ablate Persistent Atrial Fibrillation Study (COAST-AF)

University of Ottawa Heart Institute

Status

Active, not recruiting

Conditions

Persistent Atrial Fibrillation

Treatments

Procedure: Catheter ablation

Study type

Interventional

Funder types

Other

Identifiers

NCT02184013

20140623

Details and patient eligibility

About

This is a pilot study to assess the usefulness of ECG mapping, and enhanced MRI and PET scan imaging in identifying atrial fibrosis and arrhythmia circuits involved in persistent atrial fibrillation and in guiding an innovative AF catheter ablation strategy.

It is hypothesized that identifying these critical arrhythmia circuits and atrial fibrosis with enhanced imaging and performing an individualized innovative AF catheter ablation will result in higher procedural success rates.

Full description

Pulmonary vein isolation catheter ablation for the treatment of persistent AF (PeAF)or longstanding persistent AF is associated with success rates of 40-50% at one year. Experimental models have shown that AF results in progressive structural changes due to electrical atrial remodeling, where AF burden correlates with atrial fibrosis. The optimal ablation strategy for patients with PeAF is not yet known. There is limited understanding of the critical mechanisms responsible for maintenance of AF in these patients.

In this study ECG body mapping (ECGI) will be used to look for distinct electrical rotors in the atria. Delayed gadolinium enhanced magnetic resonance imaging (DE-MRI) will be used to assess the extent of left atrial fibrosis. In addition to PVI catheter ablation procedure, an ablation strategy guided by the results of the ECGI mapping and DE-MRI will be performed.A C-metahydroxyepherdrine (HED) PET scan will also be done pre-ablation to evaluate left atrial sympathetic denervation and any relationship to the initiation and/or maintenance of AF.

Subjects will be seen at 3 and 6 months after ablation, with 12 lead ECG and 2-week loop monitoring done at each visit.

Enrollment

52 patients

Sex

All

Ages

18 to 80 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Age ≥18 years and ≤ 80 years;
Symptomatic persistent AF AND clinically indicated for AF catheter ablation
At least one episode of AF lasting more than 7 days, documented on 12-lead ECG, Holter monitor, 2-week loop monitor or trans-telephonic monitor (TTM) within 12 months of enrollment in the study
Able to provide informed consent.

Exclusion criteria

History of previous catheter or surgical ablation for AF
Presence of intracardiac thrombus
contraindication to systemic oral anticoagulation therapy
Subjects with reversible causes of AF
Antero-posterior left atrial dimension > 60 mm on echocardiography
Severe valvular disease (mitral/aortic stenosis or regurgitation);
Subjects that are pregnant or breastfeeding;
Chronic kidney disease and creatinine clearance <50ml/min.
Contraindication to MRI Imaging (e.g. permanent pacemaker, metallic implants, etc)