Atrial Deganglionation as a Therapy for Cardiac Surgery Patients With Atrial Fibrillation

Study Overview
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Brief Summary
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A prospective single-arm study of ganglionated plexi ablation in cardiothoracic surgery patients with a history of atrial fibrillation.

Detailed Description
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This study assesses the use of electroporation/pulsed field ablation (PFA) to selectively ablate ganglionated plexi in cardiothoracic surgery patients with atrial fibrillation. The PFA treatment will be performed in up to 12 patients with a history of paroxysmal atrial fibrillation. The primary end point will be recurrence of atrial fibrillation out to 1 year follow-ups.

Official Title
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Atrial Deganglionation as a Therapy for Cardiac Surgery Patients With Atrial Fibrillation

Conditions
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Atrial Fibrillation

Intervention / Treatment
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* Device: Pulsed Field Ablation of epicardial Ganglionated Plexi.


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age is between 18 and 70 years. Scheduled for open-chest cardiothoracic surgery, for coronary artery bypass grafting and/or aortic valve repair/replacement Have a documented medical history of paroxysmal or early-stage persistent atrial fibrillation within the previous 12 months. Legally competent and willing to sign the informed consent. Life expectancy of at least 2 years. Exclusion Criteria: Previous cardiac surgery Prior pericardial interventions Prior endocardial or epicardial pulmonary vein isolation (PVI), or any other invasive AF therapy Previous or existing pericarditis Use of amiodarone within the previous 12 months. Long-standing persistent atrial fibrillation Indication for mitral or tricuspid valve surgery Indication for concomitant left atrial appendage (LAA) ligation or excision History of previous radiation therapy on the thorax History of previous thoracotomy. Prior electrical or mechanical isolation of the Left Atrial Appendage (LAA) The presence of LAA occlusion devices, coronary stents, prosthetic heart valves, pacemakers or implantable cardioverter defibrillators (ICDs) Myocardial infarction within the previous 2 months New York Heart Association (NYHA) Class IV heart failure symptoms Left Ventricular Ejection Fraction (LVEF) < 40%, measured by transthoracic echocardiography (TTE) Left atrial diameter > 5.0 cm, measured by transthoracic echocardiography (TTE) The presence of left atrial thrombus when examined by transesophageal echocardiography (TEE) The presence of atrial fibrillation (AF) attributable to non-cardiovascular causes such as thyroid disease, electrolyte imbalance/dehydration or other reversible causes Active infection or sepsis as evidenced by increased white blood cell count, elevated C-reactive protein (CRP) or temperature > 38.5°C Known or documented carotid stenosis > 80% Stroke or transient ischemic attack within the previous 6 months Known or documented epilepsy Pregnancy or child-bearing potential without adequate contraception Circumstances that prevent follow-ups Drug abuse Patients cannot be enrolled in another clinical study

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: GP Ablation<br>Single arm study with GP ablations performed during open-chest surgery | Device: Pulsed Field Ablation of epicardial Ganglionated Plexi.<br>* Using Pulsed Field Ablation (PFA), delivered via an epicardial catheter, to selectively ablate the ganglionated plexi (GP) on the epicardial surface of the heart.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The number of patients in sinus rhythm at 12 months. | Patients will be monitored with 24 hour Holter at 12 months | 12 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Extension of AERP | Assessment of atrial effective refractory period (AERP) immediately after sternotomy and immediately after ablation, before the index cardiothoracic surgery commences. | Day 0, peri-procedural. |