Characterization of arrhythmia substrate to ablate persistent atrial fibrillation (COAST-AF): Randomized controlled trial design and rationale.

Humans Atrial Fibrillation / surgery Prospective Studies Quality of Life Pulmonary Veins / surgery Catheter Ablation / methods Treatment Outcome Recurrence

Journal

American heart journal
ISSN: 1097-6744
Titre abrégé: Am Heart J
Pays: United States
ID NLM: 0370465

Informations de publication

Date de publication:
Dec 2022
Historique:
received: 24 04 2022
revised: 21 08 2022
accepted: 22 08 2022
pubmed: 29 8 2022
medline: 15 12 2022
entrez: 28 8 2022
Statut: ppublish

Résumé

Atrial low voltage area (LVA) catheter ablation has emerged as a promising strategy for ablation of persistent atrial fibrillation (AF). It is unclear if catheter ablation of atrial LVA increases treatment success rates in patients with persistent AF. The primary aim of this trial is to assess the potential benefit of adjunctive catheter ablation of atrial LVA in addition to pulmonary vein isolation (PVI) in patients with persistent AF, when compared to PVI alone. The secondary aims are to evaluate safety outcomes, the quality of life and the healthcare resource utilization. A multicenter, prospective, parallel-group, 2-arm, single-blinded randomized controlled trial is under way (NCT03347227). Patients who are candidates for catheter ablation for persistent AF will be randomly assigned (1:1) to either PVI alone or PVI + atrial LVA ablation. The primary outcome is 18-month documented event rate of atrial arrhythmia (AF, atrial tachycardia or atrial flutter) post catheter ablation. Secondary outcomes include procedure-related complications, freedom from atrial arrhythmia at 12 months, AF burden, need for emergency department visits/hospitalization, need for repeat ablation for atrial arrhythmia, quality of life at 12 and 18 months, ablation time, and procedure duration. Characterization of Arrhythmia Mechanism to Ablate Atrial Fibrillation (COAST-AF) is a multicenter randomized trial evaluating ablation strategies for catheter ablation. We hypothesize that catheter ablation of atrial LVA in addition to PVI will result in higher procedural success rates when compared to PVI alone in patients with persistent AF.

Sections du résumé

BACKGROUND BACKGROUND
Atrial low voltage area (LVA) catheter ablation has emerged as a promising strategy for ablation of persistent atrial fibrillation (AF). It is unclear if catheter ablation of atrial LVA increases treatment success rates in patients with persistent AF.
OBJECTIVE OBJECTIVE
The primary aim of this trial is to assess the potential benefit of adjunctive catheter ablation of atrial LVA in addition to pulmonary vein isolation (PVI) in patients with persistent AF, when compared to PVI alone. The secondary aims are to evaluate safety outcomes, the quality of life and the healthcare resource utilization.
METHODS/DESIGN METHODS
A multicenter, prospective, parallel-group, 2-arm, single-blinded randomized controlled trial is under way (NCT03347227). Patients who are candidates for catheter ablation for persistent AF will be randomly assigned (1:1) to either PVI alone or PVI + atrial LVA ablation. The primary outcome is 18-month documented event rate of atrial arrhythmia (AF, atrial tachycardia or atrial flutter) post catheter ablation. Secondary outcomes include procedure-related complications, freedom from atrial arrhythmia at 12 months, AF burden, need for emergency department visits/hospitalization, need for repeat ablation for atrial arrhythmia, quality of life at 12 and 18 months, ablation time, and procedure duration.
DISCUSSION CONCLUSIONS
Characterization of Arrhythmia Mechanism to Ablate Atrial Fibrillation (COAST-AF) is a multicenter randomized trial evaluating ablation strategies for catheter ablation. We hypothesize that catheter ablation of atrial LVA in addition to PVI will result in higher procedural success rates when compared to PVI alone in patients with persistent AF.

Identifiants

DOI: 10.1016/j.ahj.2022.08.010 PMID: 36030965
pubmed: 36030965
pii: S0002-8703(22)00181-8
doi: 10.1016/j.ahj.2022.08.010
pii:
doi:

Types de publication

Randomized Controlled Trial Multicenter Study Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

133-140

Informations de copyright

Copyright © 2022 Elsevier Inc. All rights reserved.

Auteurs

Pablo B Nery (PB)

Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada.. Electronic address: PNery@ottawaheart.ca.

George A Wells (GA)

Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada.; Cardiovascular Research Methods Center, University of Ottawa Heart Institute, Ottawa, Canada.

Atul Verma (A)

McGill University Health Center, Montreal, Quebec, Canada.

Jacqueline Joza (J)

McGill University Health Center, Montreal, Quebec, Canada.

Girish M Nair (GM)

Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada.

George Veenhuyzen (G)

Libin Cardiovascular Institute, University of Calgary, Calgary, Canada.

Jason Andrade (J)

Vancouver General Hospital, University of British Columbia,Vancouver, Canada.

Isabelle Nault (I)

Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Quebec City, Quebec, Canada.

Jorge A Wong (JA)

Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.

Markus Sikkel (M)

Victoria Cardiac Arrhythmia Trials, Victoria, British Columbia, Canada.

Vidal Essebag (V)

McGill University Health Center, Montreal, Quebec, Canada; Hôpital Sacré-Cœur, Université de Montréal, Montréal, Québec, Canada.

Laurent Macle (L)

Montreal Heart Institute, Montreal, Québec, Canada.

John Sapp (J)

Queen Elizabeth II Health Sciences, Halifax, Nova Scotia, Canada.

Jean-Francois Roux (JF)

CHUS-Sherbrooke, Sherbrooke, Quebec, Canada.

Allan Skanes (A)

Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.

Paul Angaran (P)

St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.

Paul Novak (P)

Victoria Cardiac Arrhythmia Trials, Victoria, British Columbia, Canada.

Damian Redfearn (D)

Kingston General Hospital, Kingston, Ontario, Canada.

Mehrdad Golian (M)

Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada.

Calum J Redpath (CJ)

Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada.

Marcio Sturmer (M)

Hôpital Sacré-Cœur, Université de Montréal, Montréal, Québec, Canada.

David Birnie (D)

Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Characterization of arrhythmia substrate to...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Troubles du rythme cardiaque › Fibrillation auriculaire › Characterization of arrhythmia substrate to...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Characterization of arrhythmia substrate to...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Mesures épidémiologiques › Démographie › État de santé › Qualité de vie › Characterization of arrhythmia substrate to...
questionsmedicales.fr › Système cardiovasculaire › Vaisseaux sanguins › Veines › Veines pulmonaires › Characterization of arrhythmia substrate to...
questionsmedicales.fr › Procédures de chirurgie opératoire › Techniques d'ablation › Ablation par radiofréquence › Ablation par cathéter › Characterization of arrhythmia substrate to...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Characterization of arrhythmia substrate to...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Caractéristiques de la maladie › Récidive › Characterization of arrhythmia substrate to...