Objective
The overall goal of this study is to use advances in mapping-technology to successfully isolate the LA from the RA with a simpler lesion set as compared to AV node ablation. By using high resolution mapping of the upper interatrial connections (Bachmann’s Bundle) and lower inter-atrial connections, we hope to refine the ablation lesion set necessary to successfully isolate these connections as part of the overall LA isolation ablation lesion set.
Background
Catheter ablation for atrial fibrillation (a rhythm control strategy) has revolutionized care, successfully eliminating atrial fibrillation in 70-80% of patients. When catheter ablation is unsuccessful, a rate control strategy, often involving pacemaker insertion and AV node ablation is pursued if rate control drugs are unsuccessful. This so called "pace and ablate" strategy involves electrically "disconnecting" the atria and ventricles of the heart. Th pacemaker then becomes responsible for maintaining heart rate. The left atrial isolation strategy aims to electrically disconnect only the atria. This leaves the heart's normal conduction system intact thus decreasing reliance on the pacemaker and potential damage to the heart long-term.
Study Outcomes
Primary
- Proportion of patients with successful disconnection of lower inter-atrial connection at the coronary sinus (CS)
- Proportion of patients with successful disconnection of the superior inter-atrial connections, at Bachmann’s Bundle (BB)
- Proportion of patients with ongoing LA-RA connections despite disconnection of both upper and lower inter-atrial connections
- Proportion of patients with ongoing connections from the left atrium to the AV node directly
Secondary
- Proportion of patients with complication attributable to mapping inter-atrial connections
- Proportion of patients with complication attributable to ablation of inter-atrial connections
Eligibility Criteria
The criteria below are a summary. Your study doctor will confirm whether this study is right for you.
Inclusion Criteria
- Patients with paroxysmal or persistent AF undergoing pacemaker and AV Node ablation at LHSC
- Prior echocardiogram in the last year
- Age > 18 years
Exclusion Criteria
- Prior single chamber (VVI) pacemaker
- Prior cardiac surgery
- Prior SVT ablation procedure
- Unable or unwell to consent
About taking part
If you would like to learn more about taking part in this study, please contact our research team using the details on this page. We can walk you through what participation involves and answer any questions.