High density mapping guided ablation for Persistent AF
High density substrate evaluation and guided ablation therapy for atrial fibrillation: Heat-AF
Royal Brompton & Harefield NHS Foundation Trust
Duration of Study in the UK
1 years, 6 months, 1 days
Atrial fibrillation (AF), often referred to as an ‘irregular heartbeat’, is the most common abnormal heart rhythm worldwide and is associated with significant complications including a five-fold increase in the risk of stroke. AF may be intermittent (termed paroxysmal) or sustained (termed persistent). Abnormal electrical activity arising in the pulmonary veins feeding into the heart is an important trigger for AF, and catheter ablation to electrically disconnect these veins from the heart has proven effective in treating paroxysmal AF.
In contrast results from this technique in patients with persistent AF are sub-optimal. A variety of ablation strategies are currently employed in the treatment of persistent AF, which in addition to electrical isolation of the pulmonary veins, are aimed at targeting other areas of the heart thought to be involved in persistent AF. However outcomes from these techniques remain modest, reflecting limitations in our understanding of the mechanisms underpinning persistent AF.
The development of omnipolar technology has raised the potential for high resolution mapping of the electrical activity in the heart and therefore better characterisation of the circuits at play in persistent AF. The aim of this study is to utilise the first iteration of omnipolar technology (HD Wave Solution software) to more accurately delineate the left atrial scar burden, and guide novel strategies for ablation.
Patients with persistent AF referred for catheter ablation on standard clinical grounds will be given the option to enrol in the study. Study participants will undergo pulmonary vein isolation in line with current clinical standards. HD Wave Solution software will be used to analyse the electrical activity of the heart to delineate areas of scar and/or abnormal electrical activity, that may have a critical role in persistent AF. The identified areas will be compared to those detected by current electroanatomical mapping tools and cardiac MRI scanning.
South Central - Oxford C Research Ethics Committee
Date of REC Opinion
3 Apr 2020
Further Information Favourable Opinion