Artificial Intelligence Guided Patient Selection for Atrial Fibrillation Catheter Ablation: Randomized Clinical Trial (AI-PAFA Trial)

Overview

Atrial fibrillation (AF) is a major cardiovascular disease with a prevalence of 1.7% of the total population in Korea, associated with 25% of ischemic stroke and 30% of heart failure, and is a major cardiovascular disease that doubles the risk of dementia. AF catheter ablation (AFCA) is an effective procedure that lowers the risk of heart failure mortality and cerebral infarction and improves cognitive or renal functions. However, the recurrence rate after the procedure is relatively high, especially in patients with long-standing persistent AF in which atrial remodeling has already progressed. Research on the prediction of treatment efficacy using artificial intelligence (AI) is being actively conducted around the world. We predicted the AFCA poor responders who will progress to permanent AF despite AFCA among a total of 3,372 patients included in the Yonsei AF Ablation cohort and the 2nd independent cohort with a long-term follow-up through AI with area under curve (AUC) 0.943. Therefore, in this prospective randomized clinical study, the difference between the patient selection for AFCA using AI algorithm and the clinical guidelines-based decision will be compared and evaluated in terms of long-term rhythm outcome.

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: June 2026

Detailed Description

Study design 1. Prospective randomization (AI-based patient selection group vs. conventional guidelines-based patient selection group) 2. Target number of subjects 340 patients (170 people in each group) 3. Rhythm follow-up schedule: 2012 American College of Cardiology(ACC)/American Heart Association(AHA)/European Society of Cardiology(ESC) guidelines (basal, 3 months, then every 6 months Holter, ECG when symptomatic) 4. Anticoagulant therapy follows 2020 ESC guidelines. 5. Evaluation of all adverse events occurring in each group and comparative evaluation of hospitalization rates, major cardiovascular attacks, and mortality Process of Patient Selection A guideline-based appropriate candidate for AFCA Randomization for AI-guide group vs. Clinical guideline-based group Poor responder selection by AI at the outpatient clinic AI-prediction outcomes should be noticed in AI-guided groups, but not in the clinical guideline-based group. Recommendation of rate control for AI-predicted poor responders All-comer ablation in guideline-based group Progress and rhythm/ECG tracking 1. Implemented according to 2012 American College of Cardiology(ACC)/American Heart Association(AHA)/Heart Rhythm Society(HRS) guidelines for AF management 2. Outpatient follow-up 1 to 2 weeks after the start of the procedure or drug treatment 3. Follow-up every 3 months after the procedure, and every 6 months thereafter 4. If the patient complains of arrhythmia symptoms, conduct an electrocardiogram at any time and follow the rhythm with a Holter or an event recorder.

Interventions

  • Procedure: Artificial Intelligence-based atrial fibrillation catheter ablation
    • Patient selection for Atrial Fibrillation Catheter Ablation(AFCA) AI-guided prediction for poor responder of AFCA in the outpatient clinic Sharing information on the AI prediction with the patient and family member Consideration of rate control in patients who were predicted as poor responders. AFCA after consent to the procedure after excluding potential poor responders Pulmonary vein isolation and additional treatment for non-pulmonary vein triggers Monitoring esophageal temperature Post-procedure rhythm follow-up is carried out according to the study design above.
  • Procedure: typical atrial fibrillation catheter ablation
    • Patient selection for Atrial Fibrillation Catheter Ablation(AFCA) Decision for AFCA based on clinical guidelines and the experience of the attending physician AFCA after consent to the procedure Pulmonary vein isolation and additional treatment for non-pulmonary vein triggers Monitoring esophageal temperature Post-procedure rhythm follow-up is carried out according to the study design above.

Arms, Groups and Cohorts

  • Experimental: Artificial Intelligence-based atrial fibrillation catheter ablation
    • catheter ablation
  • Active Comparator: typical atrial fibrillation catheter ablation
    • catheter ablation

Clinical Trial Outcome Measures

Primary Measures

  • Efficacy of Atrial Fibrillation Catheter Ablation(AFCA)
    • Time Frame: Up to 5 years
    • Efficacy evaluation: Clinical recurrence rate – Defined as AF or atrial tachycardia lasting over 30 seconds after 3 months of procedure. Rhythm monitoring based on 2012 ACC/AHA/HRS guidelines as described above.
  • safety of Atrial Fibrillation Catheter Ablation(AFCA)
    • Time Frame: Up to 5 years
    • Safety Assessment: Incidence of procedure-related complications within 30 days of procedure (thoracotomy, cerebral infarction, pericardial effusion or pericardial tamponade, inguinal puncture site hematoma, and vascular complications)

Participating in This Clinical Trial

Inclusion Criteria

1. Patients aged 20 to 80 years with a proper indication for AFCA 2. Left atrium size < 55 mm 3. AF recurred during the administration of antiarrhythmic drugs or that antiarrhythmic drugs intolerable patients 4. Patients eligible for anticoagulant therapy (to prevent thromboembolic events) Exclusion Criteria:

1. AF associated with severe cardiac anomalies or structural heart disease with hemodynamic influence 2. Patients who have difficulty in CT imaging using a contrast medium 3. Patients with a previous history of AFCA or other cardiac surgery 4. Patients with active internal bleeding 5. Inappropriate anticoagulant therapy 6. valvular atrial fibrillation (mitral stenosis>grade 2, mechanical valve) 7. Serious comorbidities 8. Patients expected to survive less than 1 year 9. People with drug or alcohol addiction 10. Those who cannot read the consent form (illiterate, foreigners, etc.) 11. Patients who are judged unsuitable for participation in clinical research by the judgment of other investigators

Gender Eligibility: All

Minimum Age: 20 Years

Maximum Age: 80 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Yonsei University
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Hui-Nam Pak, Principal Investigator, Severance Hospital, Yonsei University Health System
  • Overall Contact(s)
    • Hui-Nam Pak, 82-2-2228-8459, hnpak@yuhs.ac

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