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This study is designed to directly compare the safety and efficacy of PFA-based PVI+PWI vs PFA-based PVI+ VoM alcohol ablation in patients with Persistent AF.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Persistent AF patients receiving PVI (PFA)+ VoM alcohol ablation | PVI: General periprocedural guidance includes target activated clotting time (ACT) ≥350, catheter exchange ≤2, >10s spacing of consecutive applications, and minimization of number of PF applications per the recommended procedures below: For each pulmonary vein, a concentric ring of applications will be created using 12 (6 ostial and 6 antral) applications In case of visual gaps, additional 8 applications will be added PWI: Concentric overlapping ablations will be placed throughout the posterior wall deliberately. The catheter will be rotated once between a pair of applications; briefly, rotation is performed such that, post-rotation, the splines are situated midway between the splines' pre- rotation positions. The number of applications will be at the operator's discretion. VoM: VoM alcohol ablation procedure will be conducted before the catheter ablation. VoM will be visualized by coronary sinus venography, cannulated with an angioplasty wire and balloon and 1 cc of 98% ethanol will | ||
| PFA-based PVI+ left atrial posterior wall isolation | PVI: General periprocedural guidance includes target activated clotting time (ACT) ≥350, catheter exchange ≤2, >10s spacing of consecutive applications, and minimization of number of PF applications per the recommended procedures below: For each pulmonary vein, a concentric ring of applications will be created using 12 (6 ostial and 6 antral) applications In case of visual gaps, additional 8 applications will be added PWI: Concentric overlapping ablations will be placed throughout the posterior wall deliberately. The catheter will be rotated once between a pair of applications; briefly, rotation is performed such that, post-rotation, the splines are situated midway between the splines' pre- rotation positions. The number of applications will be at the operator's discretion. |
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| Measure | Description | Time Frame |
|---|---|---|
| Recurrence of atrial arrhythmia: any episode of AF/AT longer than 30 sec off-AAD, after the 2-month blanking period | 1 year |
| Measure | Description | Time Frame |
|---|---|---|
| • Arrhythmia-free on previously ineffective AAD without any dose-escalation | 1 year |
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Inclusion Criteria:
Exclusion Criteria:
• Previous PWI or VoM ablation procedure
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Persistent atrial fibrillation
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Andrea Natale, MD | Contact | 5125448186 | dr.natale@gmail.com | |
| Mitra Mohanty, MD MS | Contact | 512-544-8198 |
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In order to protect the privacy of the patients, only analyzed data will be shared for research purpose, at the discretion of the PI
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| ID | Term |
|---|---|
| D001281 | Atrial Fibrillation |
| ID | Term |
|---|---|
| D001145 | Arrhythmias, Cardiac |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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