Pulmonary Vein Isolation With Versus Without Continued Antiarrhythmic Drug Treatment in Subjects With Recurrent Atrial Fibrillation (POWDER-AF)

VZW Cardiovascular Research Center Aalst

Status and phase

Unknown

Phase 4

Conditions

Atrial Fibrillation

Treatments

Other: PVI-ADT

Other: PVI+ADT

Study type

Interventional

Funder types

Other

Identifiers

NCT02475642

POWDER-AF01

Details and patient eligibility

About

The purpose of this study is to compare the efficacy and safety of PV isolation with continued antiarrhythmic drug treatment (PVI+ADT) to PV isolation without continued ADT (PVI-ADT) in patients undergoing treatment for symptomatic recurrent AF.

Full description

Subjects that underwent PV isolation for paroxysmal or non-longstanding persistent AF and are free of arrhythmia at the end of the 3-month blanking period while taking ADT. Eligible subjects who sign the study informed consent form will be randomized into one of two study arms:

PVI+ADT Group: continue ADT through 9 months follow-up PVI-ADT Group: no ADT through 9 months follow up

Enrollment

152 patients

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

patient has continued (IC or III) ADT throughout the 3-month blanking
patient is free of symptomatic and asymptomatic AF (as evidenced by 1-day Holter) at the 3-month visit
drug-resistant (at least one class IC or III) symptomatic AF was the primary indication for prior PV isolation
in the three months prior to PVI, at least one episode of symptomatic or asymptomatic AF
PV isolation was performed according to the standards set forward by the Task Force Document (sedation or general anesthesia)
PV isolation was the only target for ablation (except for cavotricuspid (CTI) ablation if documented AFL)
PV isolation was performed by point-by-point irrigated radio frequency (RF) guided by contact-force (Biosense) (10-30gr-continuous lesion)
PV isolation (i.e. entry block) was verified in each vein after a waiting time and adenosine (with continued RF if acute reconnection)
Signed Patient Informed Consent Form.
Age 18 years or older.
Able and willing to comply with all follow-up testing and requirements.

Exclusion criteria

Longstanding persistent atrial fibrillation (>12 months of continuous AF)
Previous ablation for AF
left atrium (LA) size > 55 mm
left ventricular ejection fraction (LVEF) < 40%
AF secondary to electrolyte imbalance, thyroid disease, or reversible or non-cardiac cause
coronary artery bypass graft (CABG) procedure within the last six months
Awaiting cardiac transplantation or other cardiac surgery
Documented left atrial thrombus on imaging
Diagnosed atrial myxoma
Women who are pregnant (by history of menstrual period or pregnancy test if the history is considered unreliable) or breastfeeding
Acute illness or active systemic infection or sepsis
Unstable angina
Uncontrolled heart failure
Myocardial infarction within the previous two (2) months
History of blood clotting or bleeding abnormalities
Contraindication to anticoagulation therapy (ie, heparin or warfarin)
Life expectancy less than 12 months
Enrollment in any other study evaluating another device or drug
Presence of intramural thrombus, tumor or other abnormality that precludes catheter introduction
Patients not taking any class IC or III ADT at 3 months after PV isolation
No documentation of entry block at initial PV isolation - no waiting time or adenosine.
Additional linear ablation or defractionation during the initial procedure (except for CTI ablation for documented or induced cavo-tricuspid isthmus dependent flutter).