AblaView® Unipolar PFA OCR-guided Feasibility Study - First in Man

Prior treatment

• Previous left atrial ablation procedures, either surgical or catheter ablation.
• Prior left atrial intervention, surgical procedure, or incision with resulting scar, including AF ablation or LAA closure.
• Previous tricuspid or mitral valve replacement or repair.
• Contraindication to long-term antithromboembolic therapy.
• Has known pulmonary vein stenosis, or other anatomic or concomitant conditions that, in the investigator's opinion, could limit the subject's ability to participate in the study, comply with follow-up requirements, or impact the scientific soundness of the study results.
• Currently participating in another clinical investigation or participating in a clinical investigation that may interfere with this clinical investigation within 30 days prior to screening.

Other illness

• Arrhythmia due to reversible causes, including thyroid disorders, acute alcohol intoxication, electrolyte disorders, and other major surgical procedures in the preceding three months.
• Myocardial infarction (MI), acute coronary syndrome percutaneous coronary intervention (PCI), or valve or coronary bypass grafting surgery within the preceding 3 months.
• Presence of an implantable cardiac defibrillator (ICD).
• Heart disease for which corrective surgery is anticipated within 6 months.
• Active systemic infection.
• Bleeding diathesis or suspected procoagulant state.
• Presence of a condition that precludes appropriate vascular access.
• Severe pulmonary disease (e.g., restrictive pulmonary disease, constrictive or chronic obstructive pulmonary disease) or any other disease or malfunction of the lungs or respiratory system that produces severe chronic symptoms.
• Clinically significant psychological conditions that in the physician's opinion would prohibit the subject's ability to meet the protocol requirements.

Lab values

• Estimated glomerular filtration rate (eGFR) \< 50 mL/min/1.73 m2 or has ever received dialysis renal failure requiring dialysis.
• Severely compromised LVEF (LVEF \<40%)

Other

• Persistent or long-standing persistent AF.
• Antero-posterior Left atrial diameter \> 5.5 cm
• Body mass index \> 40.
• Known sensitivity to contrast media (if needed during the procedure) that cannot be controlled with premedication.
• Contraindication to general anesthesia (GA)
• Contraindications to computed tomography.
• Positive pregnancy test results for female subjects with childbearing potential.
• In the opinion of the Principal Investigator (PI), it is unlikely to survive the clinical investigation plan with a follow-up period of twelve months.
• The presence of intracardiac thrombus (e.g., LA), myxoma, tumor, interatrial baffle or patch or other abnormality that precludes catheter introduction or manipulation.
• Severe mitral regurgitation

• A subject will be eligible for study participation if he/she meets the following criteria:
• Symptomatic Paroxysmal Atrial Fibrillation (PAF) with at least one documented episode in the 6 previous months (according to the ESC 2020 guidelines and AHA/ACC 2023 Guidelines). Documentation may include ECG, trans-telephonic monitor (TTM), Holter monitor (HM), or telemetry strips.
• Eligible for de novo catheter intra-atrial ablation (e.g., pulmonary vein isolation).
• Eligible for Transesophageal echocardiography (TEE) or Intracardiac Echocardiography (ICE) (AHA/ACC/HRS 2014 Guidelines for AF Management pertaining to anticoagulation at the time of cardioversion and the update in 2023) performed within 24 hours of the ablation procedure in all patients with AF of 48 hours duration or of unknown duration if adequate systemic anticoagulation has not been maintained for at least 1 month prior to AF ablation.
• Antero-posterior left atrial diameter ≤ 5.5 cm as documented by transthoracic echocardiography (TTE) or computed tomography (CT) within 3 months prior to the procedure.
• Age ≥ 18 years and ≤ 85 years on the day of enrollment.
• Voluntarily accepts participation after being duly informed of the ablation procedure and its risks, as well as the remapping procedure planned three months later, by signing the informed consent form.