Substrate guided ablation version 1
Research type
Research Study
Full title
Developing Dynamic Substrate Targeted Personalised Treatment Strategies in AF.
IRAS ID
272214
Contact name
Shohreh Honarbakhsh
Contact email
Sponsor organisation
Barts Health NHS trust
Clinicaltrials.gov Identifier
Duration of Study in the UK
4 years, 11 months, 31 days
Research summary
The United Kingdom (UK) prevalence of atrial fibrillation (AF) has been reported to be 2-6% and it is anticipated that this will increase dramatically over the next decade due to an aging population. AF causes troublesome symptoms in approximately two thirds of patients and doubles the risk of mortality in both younger and older individuals. AF independently increases the risk of stroke by up to fivefold and is an independent predictor for 30-day and 1-year mortality following ischaemic stroke. Individuals with AF are also at increased risk of heart failure. AF therefore is associated with significant morbidity and mortality and has been described as a looming epidemic.
In randomised controlled trials catheter ablation has been shown to be more effective than antiarrhythmic drugs in eliminating AF, and is recommended in guidelines for symptomatic AF refractory to antiarrhythmic drugs. Success rates, allowing for a second procedure in a significant proportion, have been reported close to 90% in those for paroxysmal AF but only 65-75% for persistent AF.
Ablation strategies such as substrate modification, spectral guided ablation and localised driver ablation have been proposed with conflicting success rates. None of the current strategies formally assess the dynamic electrophysiology of the substrate. We hypothesise that the underlying substrate’s electrophysiological features influence the mechanisms driving persistent AF and the ablation strategies applied should be tailored accordingly. In this project, we will evaluate the mechanisms in relation to substrate and develop substrate specific ablation strategies. These substrate specific ablation strategies will then be evaluated in feasibility studies and the impact on freedom from AF and Atrial tachycardia will be evaluated during a follow-up of 12 months. The findings of this project will not only enhance our understanding on the mechanisms that drive persistent AF and guide us in ways of modifying disease progression but also develop ablation strategies that have the potential to improve AF catheter ablation procedural outcomes.
REC name
London - Stanmore Research Ethics Committee
REC reference
22/PR/0961
Date of REC Opinion
12 Aug 2022
REC opinion
Further Information Favourable Opinion