The Maintenance of Human Atrial Fibrillation

NCT01248156 | Completed DMC

• 2 other identifiers: 101311K24HL103800
• Study Type: observational
• Target: 5
• Locations: 1 country
• Sites: 2

Brief Summary

Atrial fibrillation (AF) is the most prevalent heart rhythm disorder in the United States, affecting 2.5 million individuals in whom it may cause stroke, palpitations, heart failure, and even death. Unfortunately, therapy for AF is limited. Anti-arrhythmic or rate-controlling drugs are poorly tolerated, with frequent side effects and do not reduce stroke risk. Ablation is an emerging, minimally invasive therapy that has attracted considerable attention because it may eliminate AF. Unfortunately, AF ablation is technically challenging, with a success of only 50-70% (versus \>90% for other arrhythmias) and serious risks. A major cause of these limitations is that the mechanisms for human AF are not known and thus ablation cannot be directed to them. As a result, AF ablation is empiric and results in extensive destruction of the atrium. This project will perform research to better understand AF and determine if abnormal activity in small regions or more widespread regions of the heart cause AF. By performing these studies in patients during clinical procedures, this project may lead to a paradigm shift in the understanding and treatment of AF.

Conditions

Atrial Fibrillation; Arrhythmias, Cardiac

Outcome Measures

Primary Outcomes (1)

• recurrence of atrial fibrillation

  recurrence of AF measured using clinical follow-up with implanted devices in all patients who consent

  1 year

Study Arms (2)

Intervention

Patients with persistent, long standing persistent and paroxysmal AF, who will receive ablation at sites that potentially maintain human AF.

Control

Patients with persistent, long standing persistent and paroxysmal AF, who receive conventional ablation as determined by the operator at each site, and based upon Heart Rhythm Society guidelines.

Eligibility Criteria

• Age: 21 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

Subjects will be men and women of all races aged above 21 years undergoing clinically indicated ablation of persistent and paroxysmal AF subjects.

You may qualify if:

• patients undergoing electrophysiology study (EPS) for ablation of (a) paroxysmal AF (non-rheumatic) whose AF episodes self-terminate in \< 7 days, or (b) persistent AF (non-rheumatic) whose AF episodes last \>or= 7 days but terminate with DC cardioversion or anti-arrhythmic drugs and do not recur within 24 hours.
• AF patients must have failed \>or= 1 anti-arrhythmic drug
• will have a full evaluation focusing on diabetes mellitus, hypertension, coronary disease, left ventricular ejection fraction (LVEF). We will document whether AF relates to times of vagal activity (meals or sleep) or exercise. We will record the use of drugs affecting the renin-aldosterone-angiotensin system (RAAS) and statins, that may protect against atrial fibrosis and AF. We will document serum potassium level, since slight elevations slow CV in vitro. We will record 12-lead ECG and echocardiography for left atrial diameter, and stress test and/or coronary angiography if indicated.
• will have event monitor recordings with daily transmissions for at least one week to document AF burden (study subjects) or exclude AF (control subjects).
• must have with-held amiodarone for \> 30 days and other anti-arrhythmic drugs for \> 5 half-lives.

You may not qualify if:

• active coronary ischemia in the past year, since the protocol uses isoproterenol
• rheumatic valve disease, that leads to distinct AF and increases thromboembolic risk
• prior ablation or cardiac surgery, that alters atrial electrophysiology
• LA clot or dense contrast on TEE
• deranged serum electrolytes, and K+ outside 4.0-5.0 mmol/l
• left atrial diameter \> 60 mm
• LVEF \< 40% or New York Heart Association heart failure \> Class II, to exclude distinct, heart-failure related remodeling
• thrombotic disease, venous filters, transient ischemic attack or cerebrovascular accident, to minimize additional risk
• pregnancy, to minimize fluoroscopy. As part of routine clinical care, all female patients of childbearing age receive a ß-HCG pregnancy test. Any who test positive will not be included in the research study
• inability or unwillingness to provide informed consent

Sponsors & Collaborators

• University of California, San Diego: lead
• National Institutes of Health (NIH): collaborator
• National Heart, Lung, and Blood Institute (NHLBI): collaborator

Study Sites (2)

University of California San Diego Medical Center

San Diego, California, 92103, United States

Location

Veterans Affairs San Diego Medical Center

San Diego, California, 92161, United States

Location

MeSH Terms

Conditions

Atrial Fibrillation; Arrhythmias, Cardiac

Condition Hierarchy (Ancestors)

Heart Diseases; Cardiovascular Diseases; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Sanjiv Narayan, MD, PhD

  University of California, San Diego

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: CASE CONTROL
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: November 24, 2010
• First Posted: November 25, 2010
• Study Start: December 1, 2010
• Primary Completion: April 1, 2014
• Study Completion: June 1, 2014
• Last Updated: August 15, 2019

Record last verified: 2019-08

Locations

US (2)