Pulmonary Vein Isolation in Athletes
| Status: | Recruiting |
|---|---|
| Conditions: | Atrial Fibrillation |
| Therapuetic Areas: | Cardiology / Vascular Diseases |
| Healthy: | No |
| Age Range: | 18 - 65 |
| Updated: | 6/27/2018 |
| Start Date: | July 17, 2017 |
| End Date: | July 2019 |
| Contact: | Kyle T Mandsager, MD |
| Email: | mandsak@ccf.org |
| Phone: | 2162132233 |
Pulmonary Vein Isolation in Athletes: Effects on Peak Performance and Pulmonary Vein Function
Pulmonary vein isolation (PVI) has become a common and effective treatment for paroxysmal and
persistent atrial fibrillation (AF), particularly in patients with drug-refractory disease.
Intense endurance exercise is a known risk factor for atrial fibrillation. In general, these
athletes poorly tolerate most common antiarrhythmic drugs used for atrial fibrillation
control and often PVI is recommended for durable management. While the efficacy of PVI in
athletes is similar to the general AF population, some athletes with lone atrial fibrillation
report a reduction in subjective exertional capacity following PVI, despite maintenance of
sinus rhythm and absence of pulmonary vein stenosis on imaging. The investigators hypothesize
that PVI may alter pulmonary vein function and affect peak exercise performance.
The investigators propose a small, prospective study of endurance athletes undergoing antral
PVI for treatment of lone atrial fibrillation. Peak metabolic performance and pulmonary vein
function will be assessed pre- and post-PVI by metabolic stress testing and cardiac MRI,
respectively.
persistent atrial fibrillation (AF), particularly in patients with drug-refractory disease.
Intense endurance exercise is a known risk factor for atrial fibrillation. In general, these
athletes poorly tolerate most common antiarrhythmic drugs used for atrial fibrillation
control and often PVI is recommended for durable management. While the efficacy of PVI in
athletes is similar to the general AF population, some athletes with lone atrial fibrillation
report a reduction in subjective exertional capacity following PVI, despite maintenance of
sinus rhythm and absence of pulmonary vein stenosis on imaging. The investigators hypothesize
that PVI may alter pulmonary vein function and affect peak exercise performance.
The investigators propose a small, prospective study of endurance athletes undergoing antral
PVI for treatment of lone atrial fibrillation. Peak metabolic performance and pulmonary vein
function will be assessed pre- and post-PVI by metabolic stress testing and cardiac MRI,
respectively.
Endurance athletes with paroxysmal or persistent atrial fibrillation undergoing primary
pulmonary vein isolation will be prospectively enrolled prior to PVI.
Patients will undergo metabolic exercise stress testing as well as resting CMR 1-4 weeks
prior to PVI. Metabolic stress testing and CMR will be repeated at 6 month follow-up. Quality
of life questionnaires will also be collected at pre- and post-PVI visits. Metabolic
treadmill stress testing will follow standard protocol and measure hemodynamics with
escalating metabolic output and characterize peak exercise capacity (METs) and oxygen
consumption (VO2 max).
CMR evaluation will include standard anatomic imaging of pulmonary vein and left atrial
anatomy at rest. Additional cine CMR sequences willbe included for focused evaluation of
dynamic pulmonary vein cross-sectional area. 3D navigator whole heart imaging and MRA (single
gadolinium dose) will be obtained to measure pulmonary vein flow. CMR sequences to
characterize left atrial function, including phasic volumes and emptying fractions (total,
passive, active) will also be performed.
Data on heart rate variability will additionally be collected at pre- and post-PVI clinic
visits, as well as the morning after PVI (hospital day 1).
pulmonary vein isolation will be prospectively enrolled prior to PVI.
Patients will undergo metabolic exercise stress testing as well as resting CMR 1-4 weeks
prior to PVI. Metabolic stress testing and CMR will be repeated at 6 month follow-up. Quality
of life questionnaires will also be collected at pre- and post-PVI visits. Metabolic
treadmill stress testing will follow standard protocol and measure hemodynamics with
escalating metabolic output and characterize peak exercise capacity (METs) and oxygen
consumption (VO2 max).
CMR evaluation will include standard anatomic imaging of pulmonary vein and left atrial
anatomy at rest. Additional cine CMR sequences willbe included for focused evaluation of
dynamic pulmonary vein cross-sectional area. 3D navigator whole heart imaging and MRA (single
gadolinium dose) will be obtained to measure pulmonary vein flow. CMR sequences to
characterize left atrial function, including phasic volumes and emptying fractions (total,
passive, active) will also be performed.
Data on heart rate variability will additionally be collected at pre- and post-PVI clinic
visits, as well as the morning after PVI (hospital day 1).
Inclusion Criteria:
- Paroxysmal or Persistent AF
- Endurance or highly trained athletes (>3H training/week for >10 yrs)
- NSR at time of stress testing
Exclusion Criteria:
- Structural Heart Disease; LVEF <45%
- Moderate or Severe Valvular disease
- eGFR < 30
- Contraindication to MRI
- Less than average functional capacity
- Previous episode of AF of >14 days duration
- Previous pulmonary vein isolation
- Imaging evidence of pulmonary vein stenosis
We found this trial at
1
site
2049 E 100th St
Cleveland, Ohio 44106
Cleveland, Ohio 44106
(216) 444-2200
Principal Investigator: Bryan Baranowski, MD
Phone: 216-213-2233
Cleveland Clinic Foundation The Cleveland Clinic (formally known as The Cleveland Clinic Foundation) is a...
Click here to add this to my saved trials
