The CASA-AF trial is a randomized controlled trial designed to compare the effectiveness and safety of thoracoscopic surgical ablation versus percutaneous catheter ablation in achieving freedom from atrial arrhythmia at 12 months in patients with long-standing persistent atrial fibrillation.
RCT (n=120)
Single-blind (outcome assessor)
1:1 ratio using minimisation
Yes
Does percutaneous catheter ablation improve freedom from atrial fibrillation and atrial tachycardia compared to thoracoscopic surgical ablation in adults with symptomatic long-standing persistent atrial fibrillation?
The CASA-AF trial protocol describes a randomized comparison of percutaneous catheter ablation versus thoracoscopic surgical ablation for the treatment of long-standing persistent atrial fibrillation.
BACKGROUND: Atrial fibrillation is the commonest arrhythmia which raises the risk of heart failure, thromboembolic stroke, morbidity and death. Pharmacological treatments of this condition are focused on heart rate control, rhythm control and reduction in risk of stroke. Selective ablation of cardiac tissues resulting in isolation of areas causing atrial fibrillation is another treatment strategy which can be delivered by two minimally invasive interventions: percutaneous catheter ablation and thoracoscopic surgical ablation. The main purpose of this trial is to compare the effectiveness and safety of these two interventions. METHODS/DESIGN: Catheter Ablation versus Thoracoscopic Surgical Ablation in Long Standing Persistent Atrial Fibrillation (CASA-AF) is a prospective, multi-centre, randomised controlled trial within three NHS tertiary cardiovascular centres specialising in treatment of atrial fibrillation. Eligible adults (n = 120) with symptomatic, long-standing, persistent atrial fibrillation will be randomly allocated to either catheter ablation or thoracoscopic ablation in a 1:1 ratio. Pre-determined lesion sets will be delivered in each treatment arm with confirmation of appropriate conduction block. All patients will have an implantable loop recorder (ILR) inserted subcutaneously immediately following ablation to enable continuous heart rhythm monitoring for at least 12 months. The devices will be programmed to detect episodes of atrial fibrillation and atrial tachycardia ≥ 30 s in duration. The patients will be followed for 12 months, completing appropriate clinical assessments and questionnaires every 3 months. The ILR data will be wirelessly transmitted daily and evaluated every month for the duration of the follow-up. The primary endpoint in the study is freedom from atrial fibrillation and atrial tachycardia at the end of the follow-up period. DISCUSSION: The CASA-AF Trial is a National Institute for Health Research-funded study that will provide first-class evidence on the comparative efficacy, safety and cost-effectiveness of thoracoscopic surgical ablation and conventional percutaneous catheter ablation for long-standing persistent atrial fibrillation. In addition, the results of the trial will provide information on the effects on patients' quality of life. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN18250790 . Registered on 24 April 2015.
Khan et al. (Tue,) conducted a rct in Long-standing persistent atrial fibrillation (LSPAF) (n=120). Thoracoscopic surgical ablation vs. Percutaneous catheter ablation was evaluated on Freedom from atrial arrhythmia (AF/AT ≥ 30 s) after a single ablation procedure and without anti-arrhythmic drugs during 12 months of follow-up. The CASA-AF trial is a randomized controlled trial designed to compare the effectiveness and safety of thoracoscopic surgical ablation versus percutaneous catheter ablation in achieving freedom from atrial arrhythmia at 12 months in patients with long-standing persistent atrial fibrillation.