The Dynamics of Human Atrial Fibrillation

Study Overview
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Brief Summary
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Atrial fibrillation (AF) is an enormous public health problem in the United States, affecting 2-5 million Americans and causing rapid heart beats, stroke, heart failure or death. In this project, the applicant will develop a novel framework to better understand human AF that builds on agreement between several concepts for the disease. The applicant will develop strategies to identify AF patients who will best respond to each of several therapies, to guide personalized therapy.

Detailed Description
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The specific aim of this clinical study is to identify patients who will or will not respond to PVI, PVI plus other ablation or Maze surgery based on locations of organized-to-disorganized areas and clinical profile. We will develop non-invasive ECGI and intracardiac recordings in our registry, then test them prospectively in an observational study. Premise: Identifying responders or non-responders to PVI alone, or PVI plus other ablation or Maze surgery may enable patient-tailored therapy. This may raise overall success, reduce risks from unsuccessful procedures and improve resource utilization(58,128-130). This proposal will prospectively test in single-arm observations studies if patients who exhibit large organized AF areas at planned ablation regions have higher procedural success than patients with smaller areas. We will use non-invasive ECGI indices of organized AF, based on Preliminary data(9, 84, 85). This project is significant because it will establish a deeper understanding of AF and will develop strategies to identify AF patients who will best respond to each of several therapies, to guide personalized therapy.

Official Title
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The Dynamics of Human Atrial Fibrillation

Conditions
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Atrial Fibrillation, Arrhythmias, Cardiac

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: referred for ablation or Maze surgery at Stanford Medicine for persistent AF (i.e. which requires cardioversion to terminate and/or lasts >7 days) Per our clinical practice and guidelines (Calkins et al., Heart Rhythm 2018), patients will have failed or be intolerant of >or= 1 anti-arrhythmic drug. Patients after Maze surgery typically have failed prior endocardial ablation. Exclusion Criteria: active coronary ischemia or decompensated heart failure atrial or ventricular clot on trans-esophageal echocardiography pregnancy (to minimize fluoroscopic exposure) inability or unwillingness to provide informed consent rheumatic valve disease (results in a unique AF phenotype) thrombotic disease or venous filters prior chest surgery is a relative contraindication for Maze surgery

Ages Eligible for Study
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Minimum Age: 22 Years
Maximum Age: 80 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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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patients Undergoing Clinically-Indicated Maze Surgery<br>This group includes patients with persistent AF who will be undergoing clinically-indicated Maze surgery. | |
| Patients Undergoing Clinically-Indicated Ablation<br>This groups includes patients with persistent AF who will be undergoing clinically-indicated ablation. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Does the Area of Organized Regions in AF predict success from Ablation? | We will map areas of organized activity in all patients. We will compare if patients with success from ablation (absence of recurrent AF or atrial tachycardia on outpatient monitoring) have larger organized areas than those without success. | 1 year. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Does ablation through larger organized areas explain success from ablation. | We will map areas of organized activity in all patients. We will compare if patients with ablation lesions through organized areas, or that eliminates organized areas, have higher or lower success from ablation (determined by absence of recurrent AF or atrial tachycardia on outpatient monitoring) than patients in whom ablation did not encroach on organized areas. | 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ablation, arrhythmias, cardiac, atrial fibrillation