Surgical Pulmonary Vein Isolation Efficiency Study

Study Overview
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Brief Summary
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A substantial proportion of patients undergoing elective coronary artery bypass grafting have a history of paroxysmal atrial fibrillation. Paroxysmal atrial fibrillation has adverse short-and long term postoperative effects. Pulmonary vein isolation (PVI) seems to be effective treatment for paroxysmal atrial fibrillation. PVI can be done concomitantly with coronary artery bypass grafting, aortic valve replacement for aortic stenosis and combination of them. Procedure is well defined and safe. There is a lack of convincing evidence of the effect on postoperative atrial fibrillation burden, quality of life and symptoms especially in correlation with atrial fibrillation paroxysms.

Official Title
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Concomitant Pulmonary Vein Isolation in Treatment of Paroxysmal Atrial Fibrillation Patients Undergoing Elective Coronary Artery Bypass Grafting and Aortic Valve Replacement for Aortic Stenosis: a Prospective Study

Conditions
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Paroxysmal Atrial Fibrillation, Coronary Artery Disease

Intervention / Treatment
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* Procedure: CABG, AVR or CABG+AVR and PVI
* Procedure: CABG, AVR or CABG+AVR


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: American College of Cardiology (ACC)/ American Heart Association (AHA) -Indications for CABG At least 2 ECG-verified (12-channel ECG, Holter telemetry) symptomatic paroxysmal atrial fibrillation episodes within last 12 months Duration of the atrial fibrillation episode must not exceed 1 week and it must reverse to sinus rhythm spontaneously or by cardioversion written and verbal consent Exclusion Criteria: Prior cardiac surgery Active pacemaker treatment Active anti-arrhythmic treatment(AAD) class I and III Contraindication to oral anticoagulant/heparin treatment Ejection fraction less than 30 % (EF < 30 %)assessed by transthoracic echocardiography Left atrial diameter less than 55mm assessed by transthoracic echocardiography Renal insufficiency requiring dialysis Heart valve disease requiring invasive treatment Heart anomaly requiring regular controls and/or invasive treatment

Ages Eligible for Study
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Minimum Age: 18 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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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: CABG, AVR or CABG+AVR and PVI<br>Coronary artery bypass (CABG), aortic valve replacement for aortic stenosis (AVR) or combination (CABG+AVR) using cardio-pulmonary bypass (CBP) and occlusion. Concomitant pulmonary vein isolation (PVI) in CBP prior to occlusion and CABG | Procedure: CABG, AVR or CABG+AVR and PVI<br> <br> |
| Active Comparator: CABG, AVR or CABG+AVR<br>Coronary artery bypass (CABG), aortic valve replacement for aortic stenosis(AVR) or combination(CABG+AVR) using cardio-pulmonary bypass (CBP) and occlusion. No operative procedures for the treatment of atrial fibrillation | Procedure: CABG, AVR or CABG+AVR<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Atrial fibrillation burden | Atrial fibrillation burden is defined as the amount of atrial fibrillation on one week Holter monitoring | Within one year after operative treatment | 
| Freedom of symptomatic and asymptomatic atrial fibrillation after surgery | Atrial fibrillation is defined as atrial fibrillation paroxysm lasting at least 60 seconds. Freedom of atrial fibrillation is defined as duration of atrial fibrillation less than 0,5% of the one week Holter monitoring | Within one year after operative treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Compare quality of life (QOL) and symptoms, correlation of symptoms with atrial fibrillation |  | Within one year after operative treatment | 
| Adverse events after surgery in both arms |  | Within one year after operative treatment | 
| Anti-arrhythmic treatment after surgery |  | Within one year after treatment | 
| Hospitalization due to atrial fibrillation after surgery |  | Within one year after operative treatment | 
| Cardioversion for the treatment of atrial fibrillation after surgery |  | Within one year after operative treatment | 
| Other cardiovascular related events: death, stroke, cardiac infarction, need for revascularization and bleeding |  | Within one year after operative treatment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Pulmonary vein isolation, Paroxysmal atrial fibrillation, Quality of life