The Thrombotic Potential of Heart Chambers in the Presence or Absence of Atrial Fibrillation.

Study Overview
=================
Brief Summary
-----------------
The investigators aim to test the thrombotic potential of various heart chambers including left atrium, left atrial appendage, right atrium and peripheral veins. Blood samples will be taken from the different chambers in 50 patients admitted for standard pulmonary vein ablation and compared to patients without atrial fibrillation admitted for left sided supra ventricular tachycardia or mitral clip. Thrombin generation parameters will be assessed by the calibrated automated thrombogram.

Detailed Description
-----------------
Atrial fibrillation is the most common arrhythmia, there is a strong correlation between atrial fibrillation and embolic stroke. In order to lower the risk for embolic stroke anticoagulation is recommended for patients with CHADS-VASC score equal or above 2. The mechanism for thrombus formation in the left atrium is thought to be caused by various factors 1. blood stasis due to the loss of atrial kick 2. endothelial dysfunction 3. blood hemostatic alteration leading to procoagulant state. Previous studies demonstrated increased thrombin generation in the left atrium in patients with atrial fibrillation, when compared to other heart chambers and when compared to control group in patients with structurally normal heart. In recent years calibrated automated thrombogram (CAT) is considered a good indicator for total thrombotic activity in hypercoagulable states. In the current study the investigators aim to test the thrombotic potential of various heart chambers including left atrium, left atrial appendage, right atrium and peripheral veins. Blood samples will be taken from the different chambers in 50 patients admitted for standard pulmonary vein ablation without changing the course of the procedure. Thrombin generation parameters will be assessed by the calibrated automated thrombogram. A control group composed of 50 patients admitted for standard left sided supra ventricular tachycardia ablation or patients admitted to mitral clip procedure without the presence of atrial fibrillation. In addition demographic data,CHADS-VASC score, atrial fibrillation burden, echocardiographic and cardiac CT parameters will be collected.

Official Title
-----------------
The Thrombotic Potential (Thrombin Generation) of Left Atrium and Other Heart Chambers in Atrial Fibrillation Patients Compared to Patients Without Atrial Fibrillation.

Conditions
-----------------
Atrial Fibrillation, Thrombosis Cardiac, Left Atrial Thrombosis

Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Age above 18 Pulmonary vein ablation, SVT ablation or mitral clip. Informed consent Exclusion Criteria: Left atrial thrombus Pregnancy Active malignancy Thrombophilia Anticoagulants 24 hours before procedure Active infectious disease Chronic kidney disease (eGFR<30)

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Participants with atrial fibrillation<br>Patients with atrial fibrillation admitted for standard pulmonary vein ablation. | |
| Participants without atrial fibrillation<br>Patients without atrial fibrillation admitted for standard left sided supra ventricular tachycardia ablation or patients admitted to mitral clip procedure. | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ETP of various heart chambers measured by the calibrated automated thrombogram (CAT) | ETP (endogenous thrombotic potential) nM*min | 1 Day | 
| Peak height of various heart chambers measured by the calibrated automated thrombogram (CAT) | Peak height nM | 1 Day | 
| Lag time of various heart chambers measured by the calibrated automated thrombogram (CAT) | Lag time in minutes | 1 Day | 
| Time to peak of various heart chambers measured by the calibrated automated thrombogram (CAT) | Time to peak in minutes | 1 Day | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The 1 year incidence of thromboembolic events |  | 1 Year | 
| The number of participants with spontaneous echocardiographic contrast demonstrated in trans-esophageal echocardiogram (TEE) |  | 1 Days | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Thrombin generation, Calibrated automated thrombogram, Atrial fibrillation