Substrate Remodelling and Targeted Ablation in AF
Research type
Research Study
Full title
Understanding Substrate Evolution in Persistent Atrial Fibrillation to Develop Tailored Ablation Strategies
IRAS ID
356469
Contact name
Shohreh Honarbakhsh
Contact email
Sponsor organisation
Joint Research Management Office at Queen Mary's University of London
Duration of Study in the UK
4 years, 0 months, 1 days
Research summary
Atrial fibrillation (AF) is the most common heart rhythm disorder, affecting millions worldwide and causing symptoms such as palpitations, fatigue and breathlessness. It also increases the risk of stroke and heart failure, so effective treatment is essential.
A treatment for AF involves catheter ablation, a minimally invasive procedure where problematic areas of the heart are targeted. This is done by passing wires called catheters, through blood vessels at the top of the leg all the way to the heart. However, this isn’t effective for everyone and approximately half of patients experience a return of AF despite treatment.
In this researcher-led study at St Bartholomew’s Hospital (paid for by Johnson & Johnson and backed by a British Heart Foundation Intermediate Fellowship), we will used a method called electroanatomical mapping to make a 3D picture of the left atrium, the heart’s upper left chamber. To make this picture more detailed, we will then collect information – such as how strong electrical signals are (voltage), how fast and in which direction they travel through the heart to describe abnormal areas and areas of scar within the heart. We will also gather information about the routes electricity takes and the nerve activity in the heart muscle. These detailed maps will help us understand why AF can continue indefinitely in some people, why ablation works for some people and not other and how to possibly improve how we do ablations to make them more effective.
All participants will undergo catheter ablation with these mapping methods integrated into the procedure. If AF recurs, patients will be invited for a second ablation targeting specific abnormal areas depending on the amount of scar found. This will be standardised across patients.
We will follow patients for 12 months, with structured visits at 3, 6, 9 and 12 months and 48-hour ECG recorders at 6 and 12 months. By tracking how the heart’s structure and electrical behaviour evolve, we aim to show that map-guided ablation reduces the need for further procedures, lowers healthcare costs and improves quality of life.
Ultimately, this study will provide clear, reproducible insights into AF mechanisms and yield practical guidance so clinicians can predict who will benefit from standard ablation treatment and who may require extra, map-guided treatment.
REC name
West of Scotland REC 4
REC reference
25/WS/0119
Date of REC Opinion
21 Aug 2025
REC opinion
Further Information Favourable Opinion