Cerebral Embolism (CE) in Catheter Ablation of Atrial Fibrillation (AF) - Full Text View

Sponsor:	Leiden University Medical Center
Information provided by:	Leiden University Medical Center
ClinicalTrials.gov Identifier:	NCT01361295

Purpose

Radiofrequency catheter ablation of atrial fibrillation (AF) induces a procoagulant state, which leads to an acute risk for symptomatic cerebral embolism (CE) of approximately 1%. The induction of a procoagulant state has been studied in pulmonary vein isolation (PVI) with a non-cooled tip catheter. The induction of a procoagulant state using a cooled-tip catheter or a cryocatheter has not been studied yet. Due to the avoidance of high endocardial temperatures, it can be expected that these procedures induce a lower level of procoagulation.

Recent studies showed an 11% incidence of CE on diffusion weighted (DW) MRI in patients undergoing cooled-tip catheter ablation of AF. In the LUMC, three different catheters are currently being used: the cooled-tip catheter, the PVAC catheter and the cryocatheter. Since the PVAC catheter is equipped with non-cooled electrodes, the risk of endothelial scarring, local thrombosis and CE may be increased.

The goal of this study is to determine the effect of three different ablation catheters on the induction of a procoagulant state and the incidence of CE on DW-MRI in patients with AF undergoing PVI.

Our hypothesis is that patients with AF undergoing PVI using the PVAC catheter will show a higher rise in procoagulation and a higher incidence of CE on DW-MRI than patients with AF undergoing PVI with the cooled-tip catheter.

Patients with AF undergoing PVI using the cryocatheter will show a lower rise in procoagulation and a lower incidence of CE on DW-MRI than patients with AF undergoing PVI with the cooled-tip catheter.

Condition	Intervention
Atrial Fibrillation	Procedure: Cryo-PVI Procedure: PVI with PVAC Procedure: PVI with Cooled-RF

Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Single Blind (Outcomes Assessor) Primary Purpose: Treatment
Official Title:	The Occurrence of Cerebral Embolism (CE) in Catheter Ablation of Atrial Fibrillation (AF) Using Three Different Ablation Catheters

Resource links provided by NLM:

Genetics Home Reference related topics: Brugada syndrome familial atrial fibrillation short QT syndrome

MedlinePlus related topics: Atrial Fibrillation

U.S. FDA Resources

Further study details as provided by Leiden University Medical Center:

Primary Outcome Measures:

Cerebral embolism [ Time Frame: Between 24 hours before the ablation and 24 hours after the ablation ] [ Designated as safety issue: Yes ]
Cerebral embolism will be documented with diffusion weighted MRI of the brain before and after ablation.

Secondary Outcome Measures:

Neuropsychological functioning [ Time Frame: Between 24 hours before the ablation until 24 hours after the ablation ] [ Designated as safety issue: Yes ]
A decrease in neuropsychological functioning will be assessed with a questionnaire before and after the procedure
Rise in procoagulation [ Time Frame: Between 24 hours before the ablation and 24 hours after the ablation ] [ Designated as safety issue: Yes ]
The procoagulant state will be assessed before, during and after the procedure by measurement of markers of endothelial damage, markers of activated coagulation, markers of fibrinolysis and by measurement of APTT, PT-INR, fibrinogen and thrombin generation.

Estimated Enrollment:	270
Study Start Date:	April 2011
Estimated Study Completion Date:	April 2014
Estimated Primary Completion Date:	April 2014 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Active Comparator: PVAC catheter	Procedure: PVI with PVAC Pulmonary vein isolation using the Medtronic PVAC catheter Other Name: Ablation Frontiers
Active Comparator: Cryoballoon catheter	Procedure: Cryo-PVI Pulmonary vein isolation using the Medtronic Arctic-Front balloon 28 or 23 mm Other Name: Cryocath
Active Comparator: Cooled-RF catheter	Procedure: PVI with Cooled-RF Pulmonary vein isolation using the Biosense Webster Navistar Thermocool catheter Other Name: CARTO3 system

Detailed Description:

A total of 270 patients scheduled for a first ablation of paroxysmal AF will be included. Patients will be 1:1:1 randomized to PVI using the PVAC catheter, the cryoballoon catheter or the cooled-tip catheter.

Before the procedure, the procoagulant state will be assessed by measuring several markers of endothelial damage, activated coagulation, fibrinolysis and by measurement of fibrinogen and thrombin generation. Measurements will be repeated during and after the procedure.

Documentation of the formation of CE will be established by performing a DW-MRI before and after the ablation. The proportion of symptomatic CE will be quantified by neuropsychological tests and questionnaires.

Finally, transcranial doppler will be performed during the entire procedure to quantify the number and pattern of cerebral microembolic signals (MES).

Eligibility

Ages Eligible for Study:	18 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

suffering from drug-refractory paroxysmal atrial fibrillation
scheduled for first ablation procedure

Exclusion Criteria:

contra-indications for DW-MRI
previous AF-ablation
minors
any patient unable to undergo neuropsychological testing due to mental retardation

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01361295

Locations

Netherlands
Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands

Sponsors and Collaborators

Leiden University Medical Center

Investigators

Principal Investigator:

Serge A. Trines, MD, PhD

Cardiology, LUMC

More Information

Publications:

Sauren LD, VAN Belle Y, DE Roy L, Pison L, LA Meir M, VAN DER Veen FH, Crijns HJ, Jordaens L, Mess WH, Maessen JG. Transcranial measurement of cerebral microembolic signals during endocardial pulmonary vein isolation: comparison of three different ablation techniques. J Cardiovasc Electrophysiol. 2009 Oct;20(10):1102-7. Epub 2009 Jun 22.

Schrickel JW, Lickfett L, Lewalter T, Mittman-Braun E, Selbach S, Strach K, Nähle CP, Schwab JO, Linhart M, Andrié R, Nickenig G, Sommer T. Incidence and predictors of silent cerebral embolism during pulmonary vein catheter ablation for atrial fibrillation. Europace. 2010 Jan;12(1):52-7.

Bulava A, Slavík L, Fiala M, Heinc P, Skvarilova M, Lukl J, Krcová V, Indrák K. Endothelial damage and activation of the hemostatic system during radiofrequency catheter isolation of pulmonary veins. J Interv Card Electrophysiol. 2004 Jun;10(3):271-9.

Responsible Party:	S.A.I.P. Trines, MD, PhD, LUMC
ClinicalTrials.gov Identifier:	NCT01361295 History of Changes
Other Study ID Numbers:	CE-AF-002
Study First Received:	May 20, 2011
Last Updated:	May 25, 2011
Health Authority:	Netherlands: Medical Ethics Review Committee (METC)

Keywords provided by Leiden University Medical Center:

Atrial fibrillation
cerebral embolism
catheter ablation

Additional relevant MeSH terms:

Atrial Fibrillation
Intracranial Embolism
Embolism
Arrhythmias, Cardiac
Heart Diseases
Cardiovascular Diseases
Pathologic Processes
Intracranial Embolism and Thrombosis

Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vascular Diseases
Thromboembolism
Embolism and Thrombosis
Thrombosis

ClinicalTrials.gov processed this record on May 23, 2012