Electrophysiological Effects of NACOS and AVK on Pulmonary Veins and Left Atrium in Paroxysmal AF Catheter Ablation

Study Overview
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Brief Summary
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Atrial fibrillation (AF) is the most common cardiac arrhythmias with a constantly growing prevalence AF. The purpose of paroxysmal AF processing is to control outbreaks from these pulmonary veins, medicated way (antiarrhythmic) or interventional. Ablation (radiofrequency or cryotherapy) has become in this context recognized and effective treatment of AF. In addition, antithrombotic treatments in this context is a major treatments for the prevention of stroke (stroke). They are most often associated with antiarrhythmic treatment to prevent recurrence of AF or to slow it during a relapse. Recent experimental studies have highlighted the direct electrophysiological properties of dabigatran and rivaroxaban in the pulmonary veins and the left atrium. Dabigatran demonstrated in this study that it induced a prolongation of potential action in the pulmonary veins and the left atrium and it decreased the incidence of FA-induced by stimulation. Conversely, rivaroxaban induces shortening of the action potential in the left atrium (untested properties in the pulmonary veins). To our knowledge, apixaban and warfarin have not been studied in this context. It is therefore possible that some of the new oral anticoagulants (NACOS) or some AVK (fluindione and warfarin), have direct electrophysiological effects in the pulmonary veins and on the left atrium and could influence AF recurrences (with effect  antiarrhythmic-like or rather a pro-arrhythmic effect) after ablation.A retrospective analysis conducted at the University Hospital of Caen on very low numbers suggest that patients on dabigatran would have less pulmonary veins connected in early ablation procedure that patients on warfarin or rivaroxaban. Despite the limitations inherent in this analysis (very low numbers, retrospective analysis, unique setting and having studied his own limits), these results are consistent with the fundamental studies, and thus encourage us to pursue our hypothesis to obtain more statistical power and reliability in our measurements and results. We therefore propose the study of the electrophysiological effects of NACOS (apixaban, dabigatran, rivaroxaban) and warfarin (warfarin and fluindione) on the pulmonary veins and the left atrium of patients referred for ablation of paroxysmal AF (radiofrequency or cryotherapy ) the CHU of Caen and Tours and clinic Saint Martin Caen.

Official Title
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Study of Electrophysiological Effects of NACOS and AVK on the Pulmonary Veins and the Left Atrium of Patients Referred for Paroxysmal AF Catheter Ablation

Conditions
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Atrial Fibrillation

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All hospitalized patients for ablation of paroxysmal AF On healthy heart Sinus rhythm during the procedure Patient> 18 years Exclusion Criteria: Patient <18 years Severe Mitral valve disease, underlying heart disease Patients refusing to participate to the study

Ages Eligible for Study
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Minimum Age: 18 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 |
| --- | --- |
| referred for paroxysmal atrial fibrillation with fluindione<br> | |
| referred for paroxysmal atrial fibrillation with previscan<br> | |
| referred for paroxysmal atrial fibrillation with apixaban<br> | |
| referred for paroxysmal atrial fibrillation with rivaroxaban<br> | |
| referred for paroxysmal atrial fibrillation with dabigatran<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Reccurence of atrial fibrillation |  | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| number of active pulmonary veins | Measure at the ostia with the lasso | 1 day | 
| Spontaneous cycle length in active pulmonary veins | Measure at the ostia with the lasso | 1 day | 
| Number of connected pulmonary veins | Measure at the ostia with the lasso | 1 day | 
| Measure of refractory period for each pulmonary veins and left atria | Measure at the ostia with the lasso for each VP, and with coronary sinus for the LA. | 1 day | 
| Number of re-connected pulmonary veins with ATP |  | 1 day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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atrial fibrillation, pulmonary veins, oral anticoagulant, electrophysiology, anticoagulant drugs