Key result
Among patients with atrial fibrillation planned for pulmonary vein isolation, 40% expressed willingness to participate in a hypothetical sham-controlled trial.
Why the study?
Interpretation of trials on pulmonary vein ablation for AF is hampered by lack of blinding and sham controls, but the feasibility of a sham-controlled trial has been questioned.
Are patients with atrial fibrillation planned for pulmonary vein isolation willing to participate in a sham-controlled trial?
Observational (n=196)
Yes
Are patients with atrial fibrillation planned for pulmonary vein isolation willing to participate in a sham-controlled trial?
A sham-controlled trial for pulmonary vein isolation in atrial fibrillation appears feasible, as 40% of patients expressed willingness to participate.
Supports sham-controlled PVI trial planning in AF; leaves open actual enrollment when offered.
BACKGROUND: The interpretation of recent trials on pulmonary vein ablation (PVI) for the treatment of atrial fibrillation (AF) is hampered by the lack of blinding and sham controls. The feasibility of a sham-controlled trial has been questioned. We aimed to assess the attitude of potential participants regarding a sham-controlled trial in a common AF-patient population planned for PVI. METHODS: Patients in two tertiary care centres planned for PVI were asked for their current AF symptoms using the Atrial Fibrillation Effect on QualiTy of Life (AFEQT) questionnaire 1 day before catheter ablation. Subsequently, the study design of a hypothetical sham-controlled PVI-study was introduced, and patients were asked for their agreement in participation. Telephone follow-up of the AFEQT questionnaire was conducted 3 months after PVI. RESULTS: One hundred and ninety-six patients (mean age 64 ± 11 years, 63% male) were included. Seventy-nine (40%) patients expressed their agreement to participate in the hypothetical sham-controlled trial. An additional 7% agreed to participate if a cross-over option after three months was offered. Agreement rate was similar in patients with first and Redo-PVI and minimal, moderate or severe symptoms. Mean overall AFEQT at baseline was 55 ± 19 and improved by 25 ± 20 points after 3 months (p < 0.001 versus baseline). CONCLUSION: With a participation rate of 40% in potential study participants, a sham-controlled trial for pulmonary vein isolation seems feasible. Patient-reported symptom relief after pulmonary vein isolation is in accordance with previous randomized open studies. The benefit of PVI should be rigorously evaluated in a sham-controlled trial.
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Uhe et al. (2021) conducted an observational in Atrial fibrillation (n=196). Survey on hypothetical sham-controlled trial participation was evaluated on Agreement to participate in a hypothetical sham-controlled trial. Among patients with atrial fibrillation planned for pulmonary vein isolation, 40% expressed willingness to participate in a hypothetical sham-controlled trial.
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