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Trial registered on ANZCTR
Registration number
ACTRN12618001815257
Ethics application status
Approved
Date submitted
29/10/2018
Date registered
7/11/2018
Date last updated
7/11/2018
Date data sharing statement initially provided
7/11/2018
Type of registration
Prospectively registered
Titles & IDs
Public title
Application of Decrement-Evoked Potential (DEEP) mapping during Atrial Fibrillation Ablation
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Scientific title
An observational study of Decrement-Evoked Potential (DEEP) mapping during standard Atrial Fibrillation Ablation to establish feasibility and predictive power for Atrial Fibrillation Recurrence
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Secondary ID [1]
296447
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None.
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Universal Trial Number (UTN)
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Trial acronym
Atrial DEEP
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Atrial Fibrillation
310223
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Condition category
Condition code
Cardiovascular
308956
308956
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0
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Other cardiovascular diseases
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Intervention/exposure
Study type
Observational
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Patient registry
False
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Target follow-up duration
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Target follow-up type
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Description of intervention(s) / exposure
The study procedure involves the addition of pacing manoeuvres to map additional potentials called Decrement Evoked Potentials (DEEP), during standard procedures for ablation of persistent AF in patients who are clinically referred for an AF ablation procedure. The feasibility of delivering this pacing and measuring responses in atrial tissue will be tested, the relationship of DEEP areas to areas of scar and other signal abnormalities on voltage and activation mapping established (DEEP has recently shown promise in guiding ventricular tachycardia ablation) and the ability of DEEP to predict which patients will have AF recurrence explored. Pacing will be delivered at the end of the procedure by the electrophysiologist, after pulmonary vein isolation ablation, and will be with a drive train (S1=500ms) and extra stimulus (S2) at atrial Effective Refractory Period + 20ms, from specific protocol-specified sites in the left atrium. These include the left atrial appendage, roof, inferior-posterior wall, superior-posterior wall, anterior wall, mitral isthmus, high septum, low septum and inferior left atrium. Pacing for DEEP mapping will occur during the standard post-ablation waiting time, and will be additional to the usual ablation procedure, but will result in minimal additional procedural time compared to standard AF ablation. All analysis of DEEP will be performed offline post-procedure. Follow-up duration will be 12 months.
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Intervention code [1]
312772
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Diagnosis / Prognosis
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Comparator / control treatment
No control group
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Control group
Uncontrolled
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Outcomes
Primary outcome [1]
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Feasibility of DEEP mapping in the atrium during atrial fibrillation ablation procedure - ability to perform effectively with adequate signal quality to interpret results with reference to known DEEP parameters. Signal quality and reproducibility of electrograms will be assessed for consistency and signal-to-noise ratio and consensus from investigators obtained as to whether quality is adequate for interpretation and future application.
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Assessment method [1]
307921
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Timepoint [1]
307921
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At initial AF ablation procedure.
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Primary outcome [2]
307922
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Clinical Recurrence of Atrial Fibrillation as detected on follow-up holter monitor or 12-lead ECG.
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Assessment method [2]
307922
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Timepoint [2]
307922
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End of study follow-up (12 months).
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Secondary outcome [1]
353355
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Relationship of DEEP mapping abnormalities (location and area involved) to abnormal voltage on standard voltage mapping during atrial fibrillation ablation procedure.
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Assessment method [1]
353355
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Timepoint [1]
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At initial AF ablation procedure.
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Secondary outcome [2]
353359
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Relationship of DEEP mapping abnormalities (location and area involved) to abnormal activation patterns (for example complex fractionated atrial electrograms or re-entrant activity) on activation mapping during atrial fibrillation ablation procedure.
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Assessment method [2]
353359
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Timepoint [2]
353359
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At initial AF ablation procedure.
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Eligibility
Key inclusion criteria
Recurrent Atrial Fibrillation ablation, referred for catheter ablation.
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Unable to provide informed consent.
Pregnant women.
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Study design
Purpose
Natural history
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Duration
Longitudinal
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Selection
Defined population
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Timing
Prospective
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Statistical methods / analysis
Mean values and SDs will be calculated for normally distributed continuous variables; median and interquartile range for non-parametric data. Categorical data expressed will be expressed as percentages (ratio). Categorical data will be compared with a Fisher exact test or a chi-square test. Continuous data will be compared with the Student t test. A p value of <.05 will be considered significant. Kaplan-Meier curves for event-free survival will be constructed using the time to first AF recurrence. Comparison between both groups will be performed by log-rank statistics. Fifteen participants will be recruited from each of 5 international centres, giving 75 in total.
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
13/11/2018
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Actual
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Date of last participant enrolment
Anticipated
10/04/2019
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Actual
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Date of last data collection
Anticipated
10/04/2020
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Actual
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Sample size
Target
75
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
NSW
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Recruitment hospital [1]
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John Hunter Hospital - New Lambton
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Recruitment hospital [2]
12297
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Lake Macquarie Private Hospital - Gateshead
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Recruitment postcode(s) [1]
24488
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2305 - New Lambton
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Recruitment postcode(s) [2]
24489
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2290 - Gateshead
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Recruitment outside Australia
Country [1]
20978
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United Kingdom
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State/province [1]
20978
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London
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Country [2]
20979
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Iceland
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State/province [2]
20979
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Reykjavik
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Country [3]
20980
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Canada
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State/province [3]
20980
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Toronto
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Country [4]
20981
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Spain
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State/province [4]
20981
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Madrid
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Funding & Sponsors
Funding source category [1]
301043
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Hospital
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Name [1]
301043
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John Hunter Hospital Cardiology Department
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Address [1]
301043
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Level 3, John Hunter Hospital, Lookout Road, New Lambton, NSW 2305
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Country [1]
301043
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Australia
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Primary sponsor type
Hospital
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Name
John Hunter Hospital Cardiology Department
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Address
Level 3, John Hunter Hospital, Lookout Road, New Lambton, NSW 2305
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Country
Australia
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Secondary sponsor category [1]
300640
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None
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Name [1]
300640
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Address [1]
300640
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Country [1]
300640
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
301798
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Hunter New England Human Research Ethics Committee
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Ethics committee address [1]
301798
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Locked Bag No 1 New Lambton NSW 2305
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Ethics committee country [1]
301798
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Australia
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Date submitted for ethics approval [1]
301798
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20/06/2018
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Approval date [1]
301798
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26/10/2018
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Ethics approval number [1]
301798
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18/06/20/3.01
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Summary
Brief summary
In the proposed study, the treating electrophysiologist will use a new and more focused method to help him/her in identifying the pathological potentials that are responsible for initiation and maintenance of AF. Despite many efforts globally, there has been a lack of ability to find and prove the best targets for ablation outside the pulmonary veins for AF, which is of particular interest in improving the success of ablation for persistent AF. There is recent evidence for the DEEP method in mapping for VT procedures. The proposed method is based on a mechanistic concept that regions that participate in the initiation of AF will demonstrate significant decremental properties prior to block and reentry, when stressed by a closely coupled premature beat. This method simply requires some additional pacing and mapping of the response to this during the routine post-ablation waiting period while patients are already undergoing AF ablation.
In this study, mapping of DEEP will be performed to determine its feasibility in atrial tissue, and the presence of DEEP will be tested as a predictor of recurrence of AF during the follow-up period of 12 months. Areas of DEEP will also be compared in location and extent to abnormal voltage and complex signals seen on standard mapping (such as complex fractionated atrial electrograms and re-entrant areas). Fifteen participants will be recruited at each of 5 international centres for a total of 75 participants.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Dr Nicholas Jackson
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Address
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John Hunter Hospital Cardiology department, Lookout Road, New Lambton. NSW. 2305.
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Country
88142
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Australia
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Phone
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+61 2 49213000
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Fax
88142
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Email
88142
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[email protected]
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Contact person for public queries
Name
88143
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Dr Nicholas Jackson
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Address
88143
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John Hunter Hospital Cardiology department, Lookout Road, New Lambton. NSW. 2305.
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Country
88143
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Australia
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Phone
88143
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+61 2 49213000
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Fax
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Email
88143
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[email protected]
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Contact person for scientific queries
Name
88144
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Dr Nicholas Jackson
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Address
88144
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John Hunter Hospital Cardiology department, Lookout Road, New Lambton. NSW. 2305.
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Country
88144
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Australia
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Phone
88144
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+61 2 49213000
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Fax
88144
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Email
88144
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Undecided
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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