TY - JOUR
T1 - Characterization of arrhythmia substrate to ablate persistent atrial fibrillation (COAST-AF)
T2 - Randomized controlled trial design and rationale
AU - Nery, Pablo B.
AU - Wells, George A.
AU - Verma, Atul
AU - Joza, Jacqueline
AU - Nair, Girish M.
AU - Veenhuyzen, George
AU - Andrade, Jason
AU - Nault, Isabelle
AU - Wong, Jorge A.
AU - Sikkel, Markus
AU - Essebag, Vidal
AU - Macle, Laurent
AU - Sapp, John
AU - Roux, Jean Francois
AU - Skanes, Allan
AU - Angaran, Paul
AU - Novak, Paul
AU - Redfearn, Damian
AU - Golian, Mehrdad
AU - Redpath, Calum J.
AU - Sturmer, Marcio
AU - Birnie, David
N1 - Publisher Copyright:
Copyright © 2022 Elsevier Inc. All rights reserved.
PY - 2022/12/1
Y1 - 2022/12/1
N2 - BACKGROUND: Atrial low voltage area (LVA) catheter ablation has emerged as a promising strategy for ablation of persistent atrial fibrillation (AF). It is unclear if catheter ablation of atrial LVA increases treatment success rates in patients with persistent AF. OBJECTIVE: The primary aim of this trial is to assess the potential benefit of adjunctive catheter ablation of atrial LVA in addition to pulmonary vein isolation (PVI) in patients with persistent AF, when compared to PVI alone. The secondary aims are to evaluate safety outcomes, the quality of life and the healthcare resource utilization. METHODS/DESIGN: A multicenter, prospective, parallel-group, 2-arm, single-blinded randomized controlled trial is under way (NCT03347227). Patients who are candidates for catheter ablation for persistent AF will be randomly assigned (1:1) to either PVI alone or PVI + atrial LVA ablation. The primary outcome is 18-month documented event rate of atrial arrhythmia (AF, atrial tachycardia or atrial flutter) post catheter ablation. Secondary outcomes include procedure-related complications, freedom from atrial arrhythmia at 12 months, AF burden, need for emergency department visits/hospitalization, need for repeat ablation for atrial arrhythmia, quality of life at 12 and 18 months, ablation time, and procedure duration. DISCUSSION: Characterization of Arrhythmia Mechanism to Ablate Atrial Fibrillation (COAST-AF) is a multicenter randomized trial evaluating ablation strategies for catheter ablation. We hypothesize that catheter ablation of atrial LVA in addition to PVI will result in higher procedural success rates when compared to PVI alone in patients with persistent AF.
AB - BACKGROUND: Atrial low voltage area (LVA) catheter ablation has emerged as a promising strategy for ablation of persistent atrial fibrillation (AF). It is unclear if catheter ablation of atrial LVA increases treatment success rates in patients with persistent AF. OBJECTIVE: The primary aim of this trial is to assess the potential benefit of adjunctive catheter ablation of atrial LVA in addition to pulmonary vein isolation (PVI) in patients with persistent AF, when compared to PVI alone. The secondary aims are to evaluate safety outcomes, the quality of life and the healthcare resource utilization. METHODS/DESIGN: A multicenter, prospective, parallel-group, 2-arm, single-blinded randomized controlled trial is under way (NCT03347227). Patients who are candidates for catheter ablation for persistent AF will be randomly assigned (1:1) to either PVI alone or PVI + atrial LVA ablation. The primary outcome is 18-month documented event rate of atrial arrhythmia (AF, atrial tachycardia or atrial flutter) post catheter ablation. Secondary outcomes include procedure-related complications, freedom from atrial arrhythmia at 12 months, AF burden, need for emergency department visits/hospitalization, need for repeat ablation for atrial arrhythmia, quality of life at 12 and 18 months, ablation time, and procedure duration. DISCUSSION: Characterization of Arrhythmia Mechanism to Ablate Atrial Fibrillation (COAST-AF) is a multicenter randomized trial evaluating ablation strategies for catheter ablation. We hypothesize that catheter ablation of atrial LVA in addition to PVI will result in higher procedural success rates when compared to PVI alone in patients with persistent AF.
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U2 - 10.1016/j.ahj.2022.08.010
DO - 10.1016/j.ahj.2022.08.010
M3 - Article
C2 - 36030965
AN - SCOPUS:85143916680
SN - 0002-8703
VL - 254
SP - 133
EP - 140
JO - American Heart Journal
JF - American Heart Journal
ER -