Cryoballoon vs. Rhythmia Guided Ablation for Recurrent AFib

The study is a randomized, prospective multicenter pilot study to assess the utility and
efficacy of high-density mapping with the Rhythmia mapping system to guide PV re-isolation in
subjects with recurrent AF after an initial cryoballoon PVI compared to repeat cryoballoon
PVI.

After obtaining informed consent to participate in the study, subjects will undergo baseline
data bcollection. Subjects will then be randomized to undergo repeat PVI with either
cryoballoon ablation or repeat PVI with an IntellaNav Open-Irrigated or other approved
ablation catheters for atrial fibrillation under guidance of the Rhythmia mapping system and
IntellaMap Orion mapping catheter. The performance of repeat AF ablation, use either the
cryoballoon or Rhythmia mapping system, mapping catheter, and ablation catheters are in
accordance with standard clinical indications and practice, regardless of participation in
the study.

The participants in the study will undergo a total of two follow-up visits after ablation
(approximately 3 and 6 months) with a 12-lead electrocardiogram (ECG) at each visit. An
assessment of rhythm will be performed with daily transmissions as well as subject-activated
event recordings for symptoms with the Kardia Mobile (AliveCor, Mountain View, CA) smartphone
based monitor. The Kardia Mobile System is an FDA-cleared, clinical grade mobile ECG monitor
coupled with a smartphone app that is able to record a single-lead ECG and securely transmit
the tracings to the study investigators via the Kardia Pro commercial (HIPPA compliant)
remote monitoring service for clinicians. The transmissions will not be directly available to
the treating electrophysiologists at each site.

At the 6 month visit, 2-weeks of continuous monitoring with a Zio XT event monitor (iRhythm,
San Francisco, CA) will be performed according to standard clinical practice to evaluate for
subclinical episodes of AF.

The goal of the pilot study is to enroll 50 subjects with 1:1 randomization across 3 sites in
the Unites States and each subject will be followed for 6 months following ablation to
evaluate for recurrence of AF. The estimated time to complete enrollment will be 3-4 months
assuming enrollment of at each visit 4-5 subject per month at each site.

Inclusion Criteria:

- Individuals with paroxysmal or persistent AF undergoing repeat AF ablation as per
recent HRS guidelines and standard practice;

- Individuals in whom the initial ablation approach was cryoballoon PVI at the enrolling
institution more than 3 month or more prior to the anticipated repeat ablation;

- Age ≥ 18 years.

Exclusion Criteria:

- Individuals with recurrent AF who previously underwent RF-based PVI;

- Individuals with known contraindications to ablation including permanent atrial
fibrillation or intolerance of anticoagulation;

- Individuals unable or not willing to complete follow-up visits and examination for the
duration of the study;

- Individuals without access to smartphone or tablet compatible with the monitoring
system;

- Prior valve surgery or surgical AF ablation;

- Individuals with mental or physical limitations precluding informed consent;

- Individuals currently enrolled in another investigational study or registry;

- Women of childbearing potential who are, or plan to become, pregnant during the time
of the study.