AzTrials
AzTrials

Long-standing Persistent Atrial FibrillationSINUSNCT06516822

CPVI With Modified Linear Ablation Versus CPVI in Patients With Long-standing Persistent Atrial Fibrillation (SINUS)

A study testing CPVI-MLA and CPVI only in people with Long-standing Persistent Atrial Fibrillation and Ablation, run by The First Affiliated Hospital with Nanjing Medical University at 10 sites in China.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
Search all trials

Trial summary

Catheter ablation has become as the first-line treatment for patients with symptomatic atrial fibrillation (AF). As the cornerstone of catheter ablation for AF, the safety and efficacy of circumferential pulmonary vein isolation (CPVI) have been confirmed. Read more about this study

Who is it for?
Ages 18 to 75 years
What is being tested?
CPVI-MLA and CPVI only
Could I receive a placebo?
No, everyone receives an active treatment
How many people
320 participants
Where
10 sitesChina
Study dates
31 Jul 2024to Dec 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • 1. Patients with symptomatic LSPAF refractory to at least one antiarrhythmic drug; LSPAF will be defined as a sustained AF episode lasting ≥ 1 year;
  • AF duration 1-3 years;
  • Age 18 - 75 years;
  • Left atrial diameter (LAD) 43-55 mm on long axis parasternal view;
  • AF recorded within 3 years of enrollment;
  • Patient willing and able to comply with protocol and sign informed consent

Who cannot join

  • Paroxysmal atrial fibrillation;
  • Persistent AF lasting < 1 year or >3 years;
  • Left atrial thrombosis;
  • Patients with a history of catheter ablation for AF;
  • Patients with severe structural heart disease (severe valvular heart disease, hypertrophic cardiomyopathy, dilated cardiomyopathy, etc.);
  • LAD > 55mm on long axis parasternal view;
Show all 33Show fewer
  • Left ventricular ejection fraction (LVEF) < 40%;
  • Patients with contraindications to low molecular weight heparin, warfarin or novel oral anticoagulants;
  • One-stop procedure for AF ablation and left atrial appendage occlusion;
  • Alcohol allergy or contrast agent allergy;
  • Patients taking cephalosporin antibiotics within 72 hours prior to ablation;
  • Pulmonary artery systolic pressure > 50mmHg;
  • Patients with unstable angina pectoris;
  • Patients who had undergone percutaneous coronary intervention (PCI) within 3 months;
  • Patients who had undergone surgery within 6 months;
  • Patients ready to receive heart transplantation;
  • Patients with a history of thromboembolism within 6 months;
  • Patients with diagnosed atrial myxoma;
  • Patients with severe respiratory diseases;
  • Patients with infectious diseases in active phase;
  • Patients with poorly controlled systemic immune diseases;
  • Patients with uncured malignant hematological diseases;
  • Patients with uncured malignant solid tumors;
  • Patients with untreated hypothyroidism or hyperthyroidism;
  • Patients with severe liver dysfunction (elevation of transaminases [ALT or AST] >3 times the upper limit of normal range);
  • Patients with end-stage renal failure requiring dialysis;
  • Patients with other serious arrhythmias, such as ventricular tachycardia with hemodynamic instability;
  • Pregnant and lactating women;
  • Patients with psychiatric ailments;
  • BMI < 18.5 or ≥ 30kg/m2;
  • Life expectancy < 2 years;
  • Patients unwilling or unable to give informed consent;
  • Patients unwilling or unable to cooperate to complete follow-up.

Trial locations and contacts

10 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Qiushi Chen, MD contact

chenqs918@163.com

10 sites in 1 country

China10 sites, 10 recruiting
  • Beijing Anzhen Hospital, Capital Medical University

    Beijing, Beijing Municipality, 100029

    Yunlong Wang, Professor, Yunlong76818@126.com

    Not yet recruiting
  • Peking University third hospital

    Beijing, Beijing Municipality, Beijing

    Jin Bai, Professor, 13810700414@126.com

    Not yet recruiting
  • The First Affiliated Hospital of Dalian Medical University

    Dalian, Liaoning, 116011

    Xiaomeng Yin, Professor, dr.yinxm@163.com

    Not yet recruiting
  • Sun Yat-sen Memorial Hospital, Sun Yat-sen University

    Guangzhou, Guangdong, 510235

    Shuanglun Xie, Professor, xieshaunglun@sina.com

    Not yet recruiting
  • The First Affiliated Hospital of Shandong First Medical University

    Jinan, Shandong, 250013

    Hesheng Hu, Professor, hyperhhs@163.com

    Not yet recruiting
  • The First Affiliated Hospital of Nanjing Medical University

    Nanjing, Jiangsu, 210029

    Fengxiang Zhang, Professor, njzfx6@163.com

    Recruiting
  • Shenzhen Hospital, Fuwai Hospital, Chinese Academy of Medical Science

    Shenzhen, Guangdong, 518000

    Teng Li, Professor, gdmc99@163.com

    Not yet recruiting
  • Taizhou First People's Hospital

    Taizhou, Zhejiang, 318050

    Weili Ge, Professor, gewl@enzemed.com

    Not yet recruiting
  • Xijing Hospital, Air Force Medical University

    Xi’an, Shanxi, 710032

    Fu Yi, Professor, yi12fu56@126.com

    Not yet recruiting
  • Zhengzhou University People's Hospital, Henan Provincial People's Hospital

    Zhengzhou, Henan, 450003

    Shujuan Dong, Professor, hnsydsj@163.com

    Recruiting

Other trials in China

About this study

Official title: Circumferential Pulmonary Vein Isolation With Modified Linear Ablation Versus Circumferential Pulmonary Vein Isolation Only in Patients With Long-standing Persistent Atrial Fibrillation (SINUS)

Catheter ablation has become as the first-line treatment for patients with symptomatic atrial fibrillation (AF). As the cornerstone of catheter ablation for AF, the safety and efficacy of circumferential pulmonary vein isolation (CPVI) have been confirmed. However, for persistent AF, especially for long-standing persistent AF (LSPAF), the recurrence rate is still high. Whether the ethanol infusion (EI) into the vein of Marshall (EI-VOM) and linear ablation could improve the success rate remains controversial.

The SINUS study is a prospective, multicenter, randomized trial, which is designed to compare the efficacy and safety between CPVI with modified linear ablation (CPVI-MLA) and CPVI only for the treatment of LSPAF.

Read the detailed description

The SINUS study will include 320 patients with LSPAF undergoing catheter ablation for the first time. All patients will be randomized to either the CPVI-MLA group or CPVI only group in a 1:1 ratio. The CPVI-MLA strategy is a fixed ablation approach consisting of EI-VOM, CPVI, left atrial posterior wall isolation (PWI), linear ablation of mitral isthmus (MI), left atrial intima adjoining CS (LAI-CS) and cavo-tricuspid isthmus (CTI), and superior vena cava isolation (SVCI). The follow-up is for a minimum of 12 months with rhythm monitoring. The primary endpoint is freedom from any documented atrial arrhythmia including atrial fibrillation (AF), atrial tachycardia (AT), or atrial flutter (AFL) > 30 seconds after the initial 3 months blanking period without the use of antiarrhythmic drugs (AADs), at 12 months after the index ablation procedure.

Being tested
CPVI-MLA, CPVI only
Keywords
long-standing persistent atrial fibrillation, circumferential pulmonary vein isolation, modified linear ablation, arrhythmia-free survival

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • CPVI-MLAProcedure or surgery

    The details include: (1) EI-VOM procedure: An 8.5-French-long sheath is inserted into to the CS via the femoral vein. A JR4 catheter is inserted into the CS to identify the ostium of the VOM. Subsequently, a guide wire supported by an OTW balloon catheter is advanced into the VOM. The balloon is inflated at 6-8 atm pressure in the VOM. Ethanol is infused into VOM from distal to proximal with 3ml each time within 1-2min. After the distal EI-VOM, the balloon is deflated and adjusted to the middle part of VOM. The EI-VOM procedure in the proximal and middle part of VOM should be the same as that in the distal. After three times of EI-VOM, the contrast is injected into VOM to make it permeable and dispersed to observe the effect of alcohol ablation. (2) After EI-VOM, radiofrequency ablation is performed to achieve bilateral PVI, PWI, bidirectional block of MI and CTI, disappearance of LAI-CS potential and SVCI. (3) Any organized AT observed during the procedure is targeted as well.

  • CPVI onlyProcedure or surgery

    After reconstructing the left atrial geometry, CPVI is performed. Radiofrequency ablation should be applied at least 1-2 cm outside of the PV ostia for PVI to achieve a wide PVI ring. The mapping catheter PentaRay will be used to confirm the complete isolation of the PV antrum when all PV potentials within each antrum are abolished. If the AF persists after CPVI, direct current cardioversion is then be conducted to restore sinus rhythm. If spontaneous AFL/AT occurs during ablation, ablation is performed targeting the focal or critical isthmus under the guidance of high-density activation mapping. The endpoint of CPVI is to achieve complete entrance and exit block of all PV antra as recorded by PentaRay during sinus rhythm or CS pacing.

Study groups in NCT06516822
Study groupRoleWhat they receive
CPVI-MLAExperimentalPatients randomized to the CPVI-MLA group first undergo ethanol infusion in the vein of Marshall (EI-VOM) followed by CPVI, left atrial posterior wall isolation (PWI), linear ablation of mitral isthmus (MI), left atrial intima adjoining CS (LAI-CS) and cavo-tricuspid isthmus (CTI), and superior vena cava isolation (SVCI).
Receives: Procedure: CPVI-MLA
CPVI onlyActive comparatorPatients randomized to the CPVI group undergo right PV ablation, followed by the left PV ablation. Radiofrequency ablation should be applied at least 1-2 cm outside of the PV ostia in a wide-area circumferential pattern. Complete CPVI is achieved when all PV potentials within each antrum recorded by the high-density mapping catheter are abolished.
Receives: Procedure: CPVI only

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Freedom from any documented atrial arrhythmia off AADs

    Freedom from any documented atrial arrhythmia including atrial fibrillation (AF), atrial tachycardia (AT), or atrial flutter (AFL) > 30 seconds assessed by ECG and Holter after the initial 3 months blanking period without the use of antiarrhythmic drugs (AADs), after the index ablation procedure

    Measured: 12 months

Secondary outcomes (14)
  1. Freedom from any documented atrial arrhythmia on/off AADs

    Freedom from any documented atrial arrhythmia > 30 seconds assessed by ECG and Holter after the initial 3 month blanking period, after the index ablation procedure on/off AADs.

    Measured: 12 months

  2. Freedom from any documented AF on/off AADs

    Freedom from any documented AF episodes > 30 seconds assessed by ECG and Holter after the initial 3 month blanking period, after the index ablation procedure on/off AADs.

    Measured: 12 months

  3. Freedom from any documented AFL/AT on/off AADs

    Freedom from any documented AFL/AT episodes > 30 seconds assessed by ECG and Holter after the initial 3 month blanking period, after the index ablation procedure on/off AADs.

    Measured: 12 months

  4. AF burden

    AF burden (% time) on continuous monitoring during 12 months after the 3-months blanking period.

    Measured: 12 months

  5. Freedom from any documented AFL/AT on/off AADs in patients with successful EI-VOM

    Freedom from any documented AFL/AT episodes > 30 seconds assessed by ECG and Holter after the initial 3 month blanking period, after the index ablation procedure on/off AADs in patients with successful EI-VOM.

    Measured: 12 months

  6. AF burden in patients with successful EI-VOM

    AF burden (% time) on continuous monitoring during 12 months after the 3-months blanking period in patients with successful EI-VOM

    Measured: 12 months

  7. Freedom from AF/AFL/AT after multiple procedures

    Freedom from any documented atrial arrhythmia > 30 seconds assessed by ECG and Holter after the initial 3 month blanking period, after more than one ablation procedure on/off AADs.

    Measured: 12 months

  8. Freedom from AF after multiple procedures

    Freedom from any documented AF > 30 seconds assessed by ECG and Holter after the initial 3 month blanking period, after more than one ablation procedure on/off AADs.

    Measured: 12 months

  9. Freedom from AFL/AT after multiple procedures

    Freedom from any documented AFL/AT > 30 seconds assessed by ECG and Holter after the initial 3 month blanking period, after more than one ablation procedure on/off AADs.

    Measured: 12 months

  10. AF burden after multiple procedures

    AF burden (% time) on continuous monitoring during 12 months (after the 3-months blanking period) after multiple procedures

    Measured: 12 months

  11. Hospitalization for cardiovascular disease

    Hospitalization for cardiovascular disease (e.g., atrial arrhythmia, heart failure and coronary heart disease)

    Measured: 12 months

  12. AFEQT score change between baseline and 12-month

    Quality of life assessed by AF effect on quality-of-life (AFEQT) questionnaire

    Measured: 12 months

  13. EQ-5D-5L score change between baseline and 12-month

    Quality of life assessed by EuroQol 5-dimension (EQ-5D-5L) scale

    Measured: 12 months

  14. Incidence of procedural complications

    Cardiac tamponade or perforation, phrenic nerve injury, acute coronary occlusion, death, stroke / thromboembolism related to AF ablation, pulmonary vein stenosis, left atrial oesophageal fistula, and vascular complications requiring intervention (e.g., pseudoaneurysm, arteriovenous fistula).

    Measured: Within 3 months after the procedure

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 Jul 2024
  2. Study start31 Jul 2024
  3. Primary completionDec 2027 (estimated)
  4. Study completionDec 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
320 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06516822
Sponsor's protocol ID
2023-SR-027.A1
Acronym
SINUS
Status last verified
Nov 2024
First submitted
17 Jul 2024
Last updated
8 Nov 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: The data used and analyzed to support the study are available from the principal investigator on reasonable request.

Questions about this trial

What is this clinical trial studying?

A study testing CPVI-MLA and CPVI only in people with Long-standing Persistent Atrial Fibrillation and Ablation, run by The First Affiliated Hospital with Nanjing Medical University at 10 sites in China.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 33 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 8 Nov 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 10 sites in China. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Yan Dong, MD (+86 18651908170, dy_medical@163.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Freedom from any documented atrial arrhythmia off AADs (time frame: 12 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 Nov 2024.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in