Optimized Posterior Left Atrial Wall Ablation Strategy for PeAF

Summary

This is an open-label, multicenter, randomized parallel-controlled clinical trial. The study aims to investigate the optimal ablation method for the posterior left atrial wall in patients with persistent atrial fibrillation (PsAF).

Conditions

• Persistent Atrial Fibrillation

Interventions

PROCEDURE

PVI + Posterior Wall Isolation (PWI) + Electrogram Ablation (EGM)

PVI + Posterior Wall Isolation (PWI) + Electrogram Ablation (EGM) After performing PVI, electrogram mapping of the posterior left atrial wall is conducted. Subsequently, PWI and EGM ablation are performed. In this group, multipolar mapping catheters are used for EGM mapping. Target EGMs include spatially discrete potentials (STPs), localized short cycle length potentials (SCLPs), and focal activities.

PROCEDURE

PVI + Posterior Wall Isolation (PWI)

After performing PVI, the mapping catheter will be placed on the posterior wall to assess electrical activity and guide ablation. A bottom linear ablation (25-40W) will be performed, connecting the lowest points beneath the lower PVs. A top linear ablation (25-40W) will be conducted at the top of the left atrium, connecting the highest points above the upper PVs. If posterior wall isolation is not achieved after completing the bottom and top lines, mapping and localization of the earliest activation point within the box will be performed during pacing from the coronary sinus (CS). Posterior wall isolation will be completed by identifying and ablating local potentials at the entry and exit sites.

PROCEDURE

Pulmonary Vein Isolation (PVI) alone

The distance between the ablation lines on the posterior wall after circumferential pulmonary vein isolation should be at least 2 centimeters to limit the portion of the posterior wall within the PVI ablation zone. PVI will be confirmed by verifying entrance and exit block at the PV orifices.

Sponsors & Collaborators

• Tongji Hospital affiliated to Tongji University

  collaborator UNKNOWN

• Shanghai 10th People's Hospital

  collaborator UNKNOWN

• Shanghai Jiao Tong University Affiliated Sixth People's Hospital

  collaborator OTHER

• Shanghai Chest Hospital

  lead OTHER

Principal Investigators

• Xumin Hou, Doctor · Shanghai Chest Hospital

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2024-10-01

Primary Completion

2025-09-01

Completion

2026-01-01