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    • Cardiac Structural and Functional Predictors of Outcome in Ablation Therapy for Atrial Fibrillation

Cardiac Structural and Functional Predictors of Outcome in Ablation Therapy for Atrial Fibrillation

Contact Name: Cynthia M. Tracy, M.D.

Contact Phone: 202/741-2668

Location

 Hours of Operation
Ambulatory Care Center
22nd St NW & I St NW
Washington, DC 20037

Driving Directions
 8:30am - 5:00pm Monday - Friday

Protocol ID:

110602

Investigator Name:

Cynthia M. Tracy, M.D.

Protocol Description:

Atrial fibrillation (AF) is the most prevalent chronic arrhythmia afflicting men and women.  AF prevalence increases with age ranging from 0.5-0.7% in the 50-59 year-old age group to 9-18% prevalence in the 80 and older age group. AF is a major risk factor for embolic stroke and can lead to hemodynamic deterioration in the setting of underlying cardiomyopathy.  The development of catheter-based radiofrequency (RF) techniques designed to interrupt electrical pathways inherent to the propagation and/or conduction from the arrhythmogenic focus has created hope that AF may be curable in a large number of patients without subjecting them to pharmacologic risk. However, the patient population most amenable to therapies such as pulmonary vein isolation (PVI) is not well defined and development of objective parameters for pre-procedural evaluation would be of clinical utility.

The predictive value of pre-procedural screening of atrial and pulmonary vein morphology and atrial function in predicting PVI outcome has not been prospectively studied. In this prospective observational study, we propose to measure cardiac geometry and function in 100 patients referred for PVI. Assessment will be performed prior to PVI as well as at 3, 6 and 12 months with two and three-dimensional echocardiography , novel echo and Doppler measurements of atrial and ventricular function.   and cCardiac magnetic resonance imaging (MRI) will be used to develop a set of predictive parameters that will establish the feasibility and success of PVI in patients with paroxysmal, persistent, and permanent AF. These imaging parameters will be tested against known clinical covariates such as age, AF duration, and history of AF risk factors as well as levels of natriuretic peptides and analyzed utilizing multivariable techniques. Additionally, we will assess the role of atrial volume regression (reverse remodeling), a known phenomenon following cardioversion, in persistent maintenance of sinus rhythm.

 

Eligibility Criteria:

Inclusion Criteria:

  • Ages 18-70 years
  • History of drug-refractory paroxysmal, recurrent persistent, or permanent AF
  • Ability to provide informed consent

 

Exclusion Criteria:

  • Presence of internal pacemakers, defibrillators or other metal objects precluding MRI evaluation
  • Claustrophobia precluding MRI evaluation
  • Body size precluding MRI evaluation
  • History of limited echocardiographic study quality due to body habitus
  • History of medical or clinical follow-up non-compliance