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Atrial fibrillation is the most common serious abnormal heart rhythm affecting about 2% to 3% of the population, being associated with a 1.5- to 1.9-fold higher risk of death. Patients with paroxysmal AF in whom antiarrhythmic drug therapy does not elicit a response are potential candidates for RF ablation of AF. The success rate of RF ablation in the treatment of AF varies depending on the type and duration of AF (ie, paroxysmal vs persistent), structural remodeling of the heart, co-morbidities and the technique of the cardiac electrophysiologist, but it usually ranges from 60-80% over 1-2 years of follow-up.
To study and predict the successful outcome of RF ablation is of great clinical importance. Moreover, the detection of predictive factors for successful outcome may alter the therapeutic strategy determining a subgroup of patients in the need of more invasive management.
The study will include 150 patients scheduled to undergo pulmonary vein (PV) ablation because of non-responsive to medical therapy PAF. ECG recordings will be obtained during sinus rhythm before and after PV ablation with a 3 - channel digital recorder for 10 minutes, and digitized with a 16-bit accuracy at a sampling rate of 1000 Hz. The P wave will be analyzed using the Morlet wavelet. Other parameters to be analyzed include 12 lead surface ECG, the burden of main and secondary morphologies and echocardiographic indexes of left atrial mechanical function. Follow-up visits will be held in 3, 6 and 12 months after the ablation procedure.
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| pulmonary veins ablation's successful outcome | Other | Assessment of predictive factors in patients with successful outcome of pulmonary veins ablations and suffer from paroxysmal atrial fibrillation. |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Paroxysmal Atrial Fibrillation (PAF) relapse(s) | Primary end point is one or more PAF relapse(s) during a period of 12 months after the ablation procedure. | 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Adverse Events | Adverse Events occurred during study period | 12 months |
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Inclusion Criteria:
Exclusion Criteria:
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Patients with paroxysmal atrial fibrillation
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| Name | Affiliation | Role |
|---|---|---|
| Vassilios P Vassilikos, MD, FACC | Aristoteleion University of Thessaloniki, Hippokrateion Hospital | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hippokrateion University Hospital | Thessaloniki | Greece |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 11085966 | Background | Pappone C, Rosanio S, Oreto G, Tocchi M, Gugliotta F, Vicedomini G, Salvati A, Dicandia C, Mazzone P, Santinelli V, Gulletta S, Chierchia S. Circumferential radiofrequency ablation of pulmonary vein ostia: A new anatomic approach for curing atrial fibrillation. Circulation. 2000 Nov 21;102(21):2619-28. doi: 10.1161/01.cir.102.21.2619. | |
| 17062959 |
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| ID | Term |
|---|---|
| D001281 | Atrial Fibrillation |
| ID | Term |
|---|---|
| D001145 | Arrhythmias, Cardiac |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D010335 | Pathologic Processes |
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| Liu X, Long D, Dong J, Hu F, Yu R, Tang R, Fang D, Hao P, Lu C, Liu X, He X, Liu X, Ma C. Is circumferential pulmonary vein isolation preferable to stepwise segmental pulmonary vein isolation for patients with paroxysmal atrial fibrillation? Circ J. 2006 Nov;70(11):1392-7. doi: 10.1253/circj.70.1392. |
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| 14707026 | Background | Pappone C, Santinelli V, Manguso F, Vicedomini G, Gugliotta F, Augello G, Mazzone P, Tortoriello V, Landoni G, Zangrillo A, Lang C, Tomita T, Mesas C, Mastella E, Alfieri O. Pulmonary vein denervation enhances long-term benefit after circumferential ablation for paroxysmal atrial fibrillation. Circulation. 2004 Jan 27;109(3):327-34. doi: 10.1161/01.CIR.0000112641.16340.C7. Epub 2004 Jan 5. |
| 15851217 | Background | Xia Y, Hertervig E, Kongstad O, Ljungstrom E, Platonov P, Holm M, Olsson B, Yuan S. Deterioration of interatrial conduction in patients with paroxysmal atrial fibrillation: electroanatomic mapping of the right atrium and coronary sinus. Heart Rhythm. 2004 Nov;1(5):548-53. doi: 10.1016/j.hrthm.2004.07.016. |
| 16159868 | Background | Byrd GD, Prasad SM, Ripplinger CM, Cassilly TR, Schuessler RB, Boineau JP, Damiano RJ Jr. Importance of geometry and refractory period in sustaining atrial fibrillation: testing the critical mass hypothesis. Circulation. 2005 Aug 30;112(9 Suppl):I7-13. doi: 10.1161/CIRCULATIONAHA.104.526210. |
| 20047928 | Background | Van Beeumen K, Houben R, Tavernier R, Ketels S, Duytschaever M. Changes in P-wave area and P-wave duration after circumferential pulmonary vein isolation. Europace. 2010 Jun;12(6):798-804. doi: 10.1093/europace/eup410. Epub 2010 Jan 3. |
| 22941968 | Background | Blanche C, Tran N, Rigamonti F, Burri H, Zimmermann M. Value of P-wave signal averaging to predict atrial fibrillation recurrences after pulmonary vein isolation. Europace. 2013 Feb;15(2):198-204. doi: 10.1093/europace/eus251. Epub 2012 Aug 31. |
| 8228720 | Background | Morlet D, Peyrin F, Desseigne P, Touboul P, Rubel P. Wavelet analysis of high-resolution signal-averaged ECGs in postinfarction patients. J Electrocardiol. 1993 Oct;26(4):311-20. doi: 10.1016/0022-0736(93)90052-f. |
| 20837368 | Background | Vassilikos V, Dakos G, Chatzizisis YS, Chouvarda I, Karvounis C, Maynard C, Maglaveras N, Paraskevaidis S, Stavropoulos G, Styliadis CI, Mochlas S, Styliadis I. Novel non-invasive P wave analysis for the prediction of paroxysmal atrial fibrillation recurrences in patients without structural heart disease: a prospective pilot study. Int J Cardiol. 2011 Dec 1;153(2):165-72. doi: 10.1016/j.ijcard.2010.08.029. Epub 2010 Sep 15. |
| 22922413 | Background | Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, Hindricks G, Kirchhof P; ESC Committee for Practice Guidelines (CPG). 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J. 2012 Nov;33(21):2719-47. doi: 10.1093/eurheartj/ehs253. Epub 2012 Aug 24. No abstract available. |
| 20871135 | Background | Martinez A, Alcaraz R, Rieta JJ. Application of the phasor transform for automatic delineation of single-lead ECG fiducial points. Physiol Meas. 2010 Nov;31(11):1467-85. doi: 10.1088/0967-3334/31/11/005. Epub 2010 Sep 24. |
| 23500312 | Background | Packer DL, Kowal RC, Wheelan KR, Irwin JM, Champagne J, Guerra PG, Dubuc M, Reddy V, Nelson L, Holcomb RG, Lehmann JW, Ruskin JN; STOP AF Cryoablation Investigators. Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal trial. J Am Coll Cardiol. 2013 Apr 23;61(16):1713-23. doi: 10.1016/j.jacc.2012.11.064. Epub 2013 Mar 21. |
| 18936041 | Background | Ketels S, Houben R, Van Beeumen K, Tavernier R, Duytschaever M. Incidence, timing, and characteristics of acute changes in heart rate during ongoing circumferential pulmonary vein isolation. Europace. 2008 Dec;10(12):1406-14. doi: 10.1093/europace/eun287. Epub 2008 Oct 19. |
| D013568 |
| Pathological Conditions, Signs and Symptoms |