NCT05723536 PLAI-AF Trial: Hybrid Endo-epicardial Partial Left Atrial Isolation vs. Endocardial Ablation in Patients With Persistent Atrial Fibrillation
| NCT ID | NCT05723536 |
| Status | Recruiting |
| Phase | — |
| Sponsor | Hospital Clinic of Barcelona |
| Condition | Atrial Fibrillation |
| Study Type | INTERVENTIONAL |
| Enrollment | 80 participants |
| Start Date | 2023-10-23 |
| Primary Completion | 2027-12-31 |
Eligibility & Interventions
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What to Expect as a Participant
You will actively receive the study intervention — which may be a drug, biologic, device, or procedure.
This trial targets 80 participants in total. It began in 2023-10-23 with a primary completion date of 2027-12-31.
⚠ This information is for research awareness only. Always consult your physician before joining any clinical trial. Participation is voluntary and you may withdraw at any time.
Brief Summary
In patients with symptomatic atrial fibrillation (AF), current clinical guidelines recommend ablation for rhythm control. While percutaneous ablation has good results in patients with paroxysmal AF, it is not clear which is the best technique in patients with persistent or long-standing persistent AF. Our group performed the first randomized study of thoracoscopic epicardial ablation vs. endocardial catheter ablation (FAST Trial), which showed better results for epicardial ablation but with a higher rate of complications. Hybrid epicardial and endocardial ablation strategies have recently been described sequentially, showing better results in patients with persistent AF, but 40% of patients are still refractory to ablation. Our study aims to compare the conventional strategy (catheter ablation) with partial electrical isolation of the left atrium endo-epicardially (pulmonary veins, posterior wall and left atrial appendage) in a single procedure in the group of patients most refractory to ablation. Likewise, using magnetic resonance imaging and echocardiography to analyze the atrial remodeling factors that can predict the success and failure of both therapies. Methodology: A 1:1 randomized clinical trial in patients with persistent and long-standing persistent AF in two groups: conventional ablation vs. partial endo-epicardial isolation. Prior to ablation, cardioversion will be performed and functionality and atrial size will be verified by echocardiography, delayed-enhancement / 4D flow magnetic resonance imaging (MRI), andelectrocardiographic imaging (ECGi) will detect the degree of fibrosis and atrial remodeling. During the ablation procedure, a continuous rhythm recording device will be implanted. Likewise, at three months the MRI will be repeated to detect post-ablation fibrosis. At six months the echocardiography will be performed to assess atrial function and size. AF recurence will be assessed using an internal loop recorder within a 1-year follow-up. Main Expected Results: The expected results include: 1. an improvement in the rate of patients with no atrial arrhythmias recurrence in patients undergoing endo-epicardial ablation; 2. a lower AF burden in patients undergoing endo-epicardial ablation who have had recurrence; 3. To know the degree of atrial remodeling (including atrial fibrosis) associated with the success/failure of each technique; 4. To know the degree of fibrosis that both techniques produce; 5. To know the degree of ventricular function associated with the success/failure of each technique; 6. To know the degree of potentially lost atrial function; 7. To Compare the safety of both techniques
Eligibility Criteria
Inclusion Criteria: 1. Patients between the ages of 18 and 75, both inclusive, at the time of the consent date. 2. Patients with persistent atrial fibrillation refractory to at least one antiarrhythmic drug (Class I or III). 3. Signature of written informed consent. Exclusion Criteria: 1. Continuous Persistent atrial fibrillation of more than 4 years. 2. Moderate to severe valvular heart disease. 3. Severe atrial dilatation (left appendage AP diameter \> 55 mm or \> 50ml/m2). 4. Patients requiring concomitant cardiac surgery or with previous cardiac surgery. 5. Left ventricular ejection fraction \<40%. 6. History of pericarditis. 7. Previous stroke. 8. Presence of active infection or sepsis, esophageal ulcer stricture and/or esophageal varices. 9. Patients with renal dysfunction defined as GFR less than or equal to 40 ml/min/m2. 10. Contraindication for chronic anticoagulation. 11. Patients who have undergone prior left atrial catheter ablation for atrial fibrillation or who are receiving treatment for ventricular arrhythmia. 12. Patients with severe chronic obstructive pulmonary disease considered GOLD III. 13. Patients with active neoproliferative disease or other concomitant disease where the medical team considers that ablation places the patient at unacceptable risk. 14. Pregnant, lactating women. 15. Patients who have previously presented allergic reactions to gadolinium. 16. Patients with claustrophobia that makes it impossible to perform nuclear magnetic resonance. 17. Persistent AF \< 3 months
Contact & Investigator
Frequently Asked Questions
Who can join the NCT05723536 clinical trial?
This trial is open to participants of all sexes, aged 18 Years or older, up to 75 Years, studying Atrial Fibrillation. Full inclusion and exclusion criteria are listed in the Eligibility Criteria section. Always confirm your eligibility with the research team before applying.
Is NCT05723536 currently recruiting?
Yes, NCT05723536 is actively recruiting participants. Contact the research team at mcaste@clinic.cat for enrollment information.
Where is the NCT05723536 trial being conducted?
This trial is being conducted at Barcelona, Spain.
Who is sponsoring the NCT05723536 clinical trial?
NCT05723536 is sponsored by Hospital Clinic of Barcelona. The trial plans to enroll 80 participants.
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