Substrate remodelling and targeted ablation for persistent atrial fibrillation
Understanding Substrate Evolution in Persistent Atrial Fibrillation to Develop Tailored Ablation Strategies
This project will try using detailed 3D electrical mapping of the left atrium to guide targeted ablation (pulmonary vein reisolation, ganglionic plexi, and substrate ablation) for people with persistent atrial fibrillation undergoing their first catheter ablation.
Quick facts
| Phase | Not applicable |
|---|---|
| Study type | Interventional |
| Enrollment | 160 (estimated) |
| Ages | 18 Years and up |
| Sex | All |
| Sponsor | Barts & The London NHS Trust Academic / other |
| Locations | 1 site (London) |
| Trial ID | NCT07047235 on ClinicalTrials.gov |
What this trial studies
Patients with persistent atrial fibrillation will undergo electroanatomical mapping to create a high-resolution 3D picture of the left atrium, including measurements of voltage and conduction velocity. The mapping data will be used to identify low-voltage areas and regions of autonomic ganglia for targeted ablation in addition to pulmonary vein reisolation as indicated. The procedures are performed at St Bartholomew's Hospital and are intended for patients having their first left atrial catheter ablation. Outcomes will focus on whether this mapping-guided, substrate-directed approach reduces recurrence compared with standard strategies.
Who should consider this trial
Good fit: Adults aged 18 or older with a clinical diagnosis of persistent atrial fibrillation who are scheduled for their first catheter ablation and can give informed consent are ideal candidates.
Not a fit: People with prior left atrial ablation, those under 18, or anyone with clinical contraindications to catheter ablation are not expected to benefit from joining this programme.
Why it matters
Potential benefit: If successful, this approach could reduce the chance of atrial fibrillation coming back after a first-time ablation by tailoring treatment to each patient’s electrical substrate.
How similar studies have performed: Previous work targeting low-voltage substrate and autonomic ganglia has produced mixed results, so the technique shows promise but has not been definitively proven yet.
Eligibility criteria
Show full inclusion / exclusion criteria
Inclusion Criteria: * Able and willing to provide written informed consent * Age: 18 years or older * Clinical diagnosis: Persistent atrial fibrillation * Treatment status: Scheduled to undergo first-time catheter ablation for persistent AF Exclusion Criteria: * Inability or unwillingness to provide informed consent * Under 18 years of age * Previous left atrial ablation for AF or other atrial arrhythmias * Any clinical contraindications to undergoing AF catheter ablation
Where this trial is running
London
- St Bartholomew's Hospital — London, United Kingdom (Recruiting)
Study contacts
- Study coordinator: Shohreh Honarbakhsh, MBBS, MRCP, PhD
- Email: shohreh.honarbakhsh@nhs.net
- Phone: 02037658682
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.