An interventional study of Pulse field ablation with the PFLotus catheter in Persistent Atrial Fibrillation, sponsored by The Third People's Hospital of Chengdu. Recruiting at 1 site in China. Open to participants aged 18 Years to 75 Years. Per ClinicalTrials.gov, last updated 2025-12-24.
Sponsored by The Third People's Hospital of Chengdu · Not applicable, Interventional, and Treatment
Single-shot pulsed-field ablation (PFA) catheters maximize pulmonary vein isolation (PVI) efficiency but are limited for focal or linear ablation. The goal of this clinical trial is to evaluate the safety and effectiveness of a novel, PFA catheter that transitions between large 'petals' (single-shot), and a small, spherical 'bud' (large-focal/linear), enabling a PVI-plus strategy in patients with persistent AF (PersAF).
The main questions it aims to answer are:
This trial enrolled patients with perAF , who were treated under general anesthesia with the shape-adaptive PFA catheter (PFLotus, bipolar, biphasic, 850 V, 60 μs, EnChannel Medical).
Participants will:
Background
Catheter ablation with thermal energy sources, including radiofrequency (RF) or cryoablation, is a well-established and effective treatment for atrial fibrillation (AF), demonstrating comparable safety and efficacy in studies where pulmonary vein isolation (PVI) is the procedural endpoint. However, the non-selective diffusion of thermal energy risks collateral damage to adjacent anatomical structures, a limitation for both clinical application and technological advancement. These two catheter types each present distinct trade-offs: point-by-point RF ablation requires considerable operator skill and longer procedure times, while cryoballoon ablation, though more user-friendly, lacks precise spatial control and is less suited for mapping and ablating non-PVI targets.
Pulsed field ablation (PFA) employs high-voltage, ultra-rapid electric fields to induce irreversible electroporation and cellular death. As a non-thermal modality, PFA demonstrates preferential selectivity for cardiomyocytes. This offers the potential to create durable lesions while better preserving surrounding critical structures such as the esophagus, blood vessels, pulmonary veins, and phrenic nerve. Notably, PFA has not been associated with thermal complications like atrioesophageal fistula, phrenic nerve palsy, or pulmonary vein stenosis, suggesting it may enhance PVI effectiveness while reducing procedural risks.
Current evidence for PFA in AF management stems largely from preclinical studies and single-arm clinical trials. Early first-in-human studies with various PFA systems have reported promising outcomes. In the pivotal single-arm PULSED AF trial, PFA (PulseSelect System, Medtronic) for paroxysmal and persistent AF yielded arrhythmia recurrence rates comparable to thermal ablation, with a low rate of primary safety events at one year. The MANIFEST-PF registry reported a 99.9% acute PVI success rate, very low major complications, and reduced atrial arrhythmia recurrence relative to thermal ablation.
A recent randomized controlled trial (RCT) in persistent AF (ADVENT trial) found PFA (Farapulse System, Boston Scientific) non-inferior to conventional thermal ablation for the primary efficacy endpoint-freedom from procedural failure and post-procedural atrial tachyarrhythmias. Another RCT in persistent AF (Sphere-Per-AF trial) confirmed that PFA (Sphere-9 System, Medtronic) was comparable to thermal ablation in both effectiveness and safety, with the added advantage of shorter procedure times.
New catheter designs continue to emerge. The multi-electrode, force-sensing PFA catheter (Globe, Kardium Inc.) was developed as a single-step PVI solution. More recently, a basket-balloon hybrid PFA catheter (Volt™, Abbott) has entered first-in-human trials, with preliminary data supporting its immediate efficacy and safety in persistent AF. A recent meta-analysis concluded that PFA is associated with shorter procedure times but longer fluoroscopy times, while showing no significant differences in complication rates or AF recurrence compared to thermal ablation.
Thus, this first-in-human study aims to evaluate the safety and effectiveness of a novel, PFA catheter that transitions between large 'petals' (single-shot), and a small, spherical 'bud' (large-focal/linear), enabling a PVI-plus strategy in patients with persistent AF (PersAF).
Methods Study Design This was a first-in-human, prospective, single-arm, single-center trial evaluating the safety and efficacy of a novel a novel shape-adaptive PFA ablation catheter in PersAF patients. The study was approved by the local Ethics Committee and conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent.
Study Population Eligible patients were 18-75 years old with documented symptomatic PerAF (AF duration 7-365 days) who were refractory or intolerant to at least one Class I or III antiarrhythmic drug.
Procedural Workflow All procedures were performed under general anesthesia. The activated clotting time was maintained≥300 seconds. A decapolar catheter was positioned in the coronary sinus and a ventricular electrode in the right ventricle. Transseptal puncture was performed under fluoroscopic guidance.
An electroanatomic map of the left atrium and pulmonary veins was created using a PENTARAY® catheter and the CARTO 3 system (Biosense Webster). The PFA sheath was inserted and continuously flushed. The PFLutos catheter was advanced into the left atrium and navigated to target sites.
PVI was performed in all patients. Additional linear ablation strategies Including the left atrial posterior wall (LAPW), mitral isthmus (MI), or cavotricuspid isthmus (CTI), were performed at the operator's discretion. For MI ablation, if persistent epicardial connections were identified, adjunctive ablation within the coronary sinus was performed. After a 20-minute waiting period, isolation and block were reassessed.
Follow-up Post-ablation antiarrhythmic drug use was determined by the operator and typically discontinued after three months. Oral anticoagulation was maintained per guidelines. Structured follow-up occurred at 7 days and 3 months post-ablation, with lesion durability assessed via invasive remapping at 3 months. Additional visits were scheduled at 6 and 12 months. Atrial Tachyarrhythmia recurrence was assessed using 12-lead ECGs at each visit and 24-hour or 7-day Holter monitoring at 3, 6, and 12 months.
Endpoints The primary safety endpoint was the incidence of primary adverse events (PAEs) within 7 days post-ablation. Later-occurring events (device/procedure-related death, atrio-esophageal fistula, PV stenosis) were also classified as PAEs. Persistent diaphragmatic paralysis or phrenic nerve palsy at 3 months were considered PAEs.
The primary efficacy endpoint was acute procedural success, defined as the proportion of patients achieving: 1) complete electrical isolation of all PVs, and 2) for those undergoing linear ablation, confirmed bidirectional block at all targeted sites (LAPW, MI, CTI).
Secondary efficacy endpoints included:
4,009 studies on the registry are indexed under Atrial Fibrillation; 961 are open to participants now.
This study's planned enrollment of 40 is below the median of 150 across 2,476 interventional studies indexed under Atrial Fibrillation.
Browse Atrial Fibrillation studies →The Third People's Hospital of Chengdu is the lead sponsor of 12 studies on the registry; 7 are open to participants now.
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Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
1. Aged between 18 and 75 years (inclusive), regardless of gender 2. Diagnosed with symptomatic persistent atrial fibrillation (AF). The patient's medical records document that the duration of AF episodes exceeds 7 days or the patient has a history of persistent AF, and meets **any one** of the following criteria:
3. Poor response to treatment with at least one class I or class III antiarrhythmic drug (AAD), or intolerance to class I or class III AADs.
4. Willing to participate in the trial, comply with the follow-up requirements specified in the protocol, and sign the form.
Exclusion Criteria:
Any of the following cardiac surgeries, implants, or conditions:
History of any of the following within 3 months prior to the procedure:
History of any of the following within 3 months prior to the procedure:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
A recording of the heart’s electrical activity, taken with stickers on the chest, arms and legs. It takes a few minutes and does not hurt.
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.
The New York Heart Association’s four classes of how much heart failure limits physical activity.
Studies set their own limit — many outside heart failure leave out class III–IV, while heart failure studies may ask for a particular class. Check the class this study names.
The share of blood the heart’s main pumping chamber (the left ventricle) pushes out with each beat, measured by an echocardiogram (heart ultrasound) or a MUGA scan. About 50–70% is normal.
A “mini-stroke”: temporary stroke-like symptoms caused by reduced blood flow to part of the brain, spinal cord or eye, without signs of a new stroke on a scan.
Stroke symptoms need emergency care at once, even if they go away.
The study doctor’s estimate of how long someone is likely to live. Criteria use it so that people can stay in the study long enough for it to answer its question.
ECG (electrocardiogram)
A recording of the heart’s electrical activity, taken with stickers on the chest, arms and legs. It takes a few minutes and does not hurt.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Contraindication
A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
NYHA class (heart failure)
The New York Heart Association’s four classes of how much heart failure limits physical activity.
Studies set their own limit — many outside heart failure leave out class III–IV, while heart failure studies may ask for a particular class. Check the class this study names.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
LVEF (left ventricular ejection fraction)
The share of blood the heart’s main pumping chamber (the left ventricle) pushes out with each beat, measured by an echocardiogram (heart ultrasound) or a MUGA scan. About 50–70% is normal.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
TIA (transient ischaemic attack)
A “mini-stroke”: temporary stroke-like symptoms caused by reduced blood flow to part of the brain, spinal cord or eye, without signs of a new stroke on a scan.
Stroke symptoms need emergency care at once, even if they go away.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Life expectancy
The study doctor’s estimate of how long someone is likely to live. Criteria use it so that people can stay in the study long enough for it to answer its question.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
PVI was performed in all patients. Additional linear ablation strategies Including the left atrial posterior wall (LAPW), mitral isthmus (MI), or cavotricuspid isthmus (CTI), were performed at the operator's discretion.
Device: Pulse field ablation with the PFLotus catheter
PVI was performed in all patients. Additional linear ablation strategies Including the left atrial posterior wall (LAPW), mitral isthmus (MI), or cavotricuspid isthmus (CTI), were performed at the operator's discretion.
The primary safety endpoint
The primary safety endpoint was the incidence of primary adverse events (PAEs) within 7 days post-ablation. Later-occurring events (device/procedure-related death, atrio-esophageal fistula, PV stenosis) were also classified as PAEs. Persistent diaphragmatic paralysis or phrenic nerve palsy at 3 months were considered PAEs.
Time frame: Seven days post index ablation procedure
The primary efficacy endpoint
The primary efficacy endpoint was acute procedural success, defined as the proportion of patients achieving: 1) complete electrical isolation of all PVs, and 2) for those undergoing linear ablation, confirmed bidirectional block at all targeted sites (LAPW, MI, CTI).
Time frame: Immediately after the index ablation procedure
Rate of Acute Pulmonary Vein (PV) Isolation Success [Secondary Efficacy Endpoint]
The outcome is defined as the proportion of participants who achieve complete electrical isolation of all targeted pulmonary veins immediately after the index ablation procedure.
Time frame: Immediate after the index ablation procedure
Acute Bidirectional Block Success Rate for Each Targeted Linear Ablation Site [Secondary Efficacy Endpoint]
The outcome is defined as the proportion of each targeted linear ablation site (e.g., left atrial posterior wall \[LAPW\], mitral isthmus \[MI\], cavotricuspid isthmus \[CTI\], superior vena cava \[SVC\]) that achieves verified bidirectional block immediately after the index ablation procedure. Each linear site is assessed independently, and the success rate for each site is reported separately.
Time frame: Immediate after the index ablation procedure
Durable Bidirectional Block Success Rate for Each Targeted Linear Ablation Site at 3-Month Remapping [Secondary Efficacy Endpoint]
The outcome is defined as the proportion of each targeted linear ablation site (LAPW, MI, CTI, SVC) that maintains verified bidirectional block (without recurrence of conduction) at 3-month remapping after the index ablation procedure. Each linear site is assessed independently, and the durable success rate for each site is reported separately.
Time frame: 3 months after the index ablation procedure
1-Year Freedom from Atrial Tachyarrhythmia Recurrence [Secondary Efficacy Endpoint]
The outcome is defined as the proportion of participants who remain free from recurrent atrial tachyarrhythmias (including atrial fibrillation, atrial flutter, atrial tachycardia) within 1 year after the index ablation procedure. Recurrence is defined as any episode of atrial tachyarrhythmia lasting ≥30 seconds, confirmed by 12-lead electrocardiogram or 72-hour Holter monitoring, following the 3-month blanking period.
Time frame: 1 year after the index ablation procedure
Plan to share: Yes — De-identified IPD to be shared include baseline demographic and clinical data, procedural parameters (e.g., PFA settings, ablation sites), safety data (adverse events within 7 days and follow-up), effectiveness data, and post-PFA voltage mapping results. These IPD are all data used in the primary results publication, as sharing them supports reproducible research and advances the understanding the use of PFLotus PFA catheters in persistent AF.
Supporting information: Study protocol, Statistical analysis plan, Informed consent form, Clinical study report
Time frame: 2-year post primary publication
Access criteria: Eligible Recipients: Qualified researchers with academic/institutional affiliation, who submit a feasible research proposal and agree to comply with data protection regulations. Accessible MaterialsDe-identified individual participant data (baseline, procedural, follow-up data related to PFA/AF) and supporting documents (study protocol, statistical analysis plan, redacted clinical study report). Identifiable information and raw imaging data are excluded. Access Process Submit application (proposal, CV, IRB approval, signed DUA) to the corresponding author via designated email.
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The Third People's Hospital of Chengdu