Efficacy, Safety and Efficiency Study of CARTO® 3 System Guided THERMOCOOL® Catheter Ablation Versus Fluoroscopy Guided Ablation With the Pulmonary Vein Ablation Catheter® (PVAC®)

Phase 4TerminatedNCT01116557

Biosense Webster, Inc.79 enrolled

Overview

The purpose of this study is to compare the efficacy, safety and efficiency of CARTO® 3 system guided THERMOCOOL® catheter ablation and fluoroscopy guided Pulmonary Vein Ablation Catheter® (PVAC®) guided ablation for the treatment of paroxysmal atrial fibrillation.

This study is a prospective, multi-center, randomized (2:1), controlled, two-arm, unblinded, clinical study, which will evaluate the efficacy, safety, and efficiency of CARTO® 3 System-guided RF ablation (using the THERMOCOOL® Catheter and LASSO® Circular Mapping Catheter) compared to fluoroscopy-guided RF ablation (using the PVAC®). Patients with symptomatic PAF who meet the inclusion criteria will be considered for study participation and may be enrolled if no exclusion criteria apply. Eligible subjects who signed the study informed consent form will be randomized into one of two treatment groups: * THERMOCOOL® Group: RF ablation to achieve PVI using the CARTO® 3 System, THERMOCOOL® Catheter and LASSO® Circular Mapping Catheter * PVAC® Group: RF ablation to achieve PVI using fluoroscopy and the PVAC®

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Atrial Fibrillation

Interventions

Radiofrequency Ablation procedureDEVICE

Radiofrequency Ablation procedure Application of radiofrequency energy with the THERMOCOOL® catheter used in combination with the CARTO® 3 System and the LASSO® Circular Mapping Catheter to eliminate potentials arising from the pulmonary veins.

Radiofrequency Ablation procedureDEVICE

Application of radiofrequency energy with the Pulmonary Vein Ablation Catheter® (PVAC®) to eliminate potentials arising from the pulmonary veins.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients with PAF who have had two (2) symptomatic PAF episodes in the six (6) months prior to randomization, and who are selected for catheter ablation for the treatment of their AF. Additionally patients with recurrent AF with episodes up to 30 days with sinus rhythm maintained for more than one week following cardioversion and who require PVI only for the treatment of their AF (supported by the consensus statement2). At least one AF episode should be documented either on ECG, TTM, HM or telemetry strip. * Failure of at least one AAD for PAF \[class I or III\] as evidenced by recurrent symptomatic PAF, or intolerable side effects due to the AAD. * Signed Patient Informed Consent Form. * Age 18 years or older. * Able and willing to comply with all pre- and follow-up testing and requirements. Exclusion Criteria: * Longstanding persistent atrial fibrillation * Patients with a history of any atrial flutter requiring ablation in the right atrium during the study procedure * Patients in whom sinus rhythm was maintained for less than 1 week after electrical cardioversion * Previous ablation for AF * LA size \> 55 mm * LVEF \< 40% (ejection fraction) * AF secondary to electrolyte imbalance, thyroid disease, or reversible or non-cardiac cause * CABG procedure within the last six (6) months * Awaiting cardiac transplantation or other cardiac surgery * Documented left atrial thrombus on imaging (eg, TEE) * Diagnosed atrial myxoma * Women who are pregnant (by history of menstrual period or pregnancy test if the history is considered unreliable) or breastfeeding * Acute illness or active systemic infection or sepsis * Unstable angina * Uncontrolled heart failure * Myocardial infarction within the previous two (2) months * History of blood clotting or bleeding abnormalities * Contraindication to anticoagulation therapy (ie. heparin or warfarin) * Life expectancy less than 12 months * Enrollment in any other study evaluating another device or drug * Presence of intramural thrombus, tumor or other abnormality that precludes catheter introduction or manipulation

Outcomes

Primary Outcomes

Freedom from documented AF/AT recurrences without new AADs

Subjects will be considered a success for the primary efficacy endpoint if the subject is free from documented recurrences of AF or AT lasting more than 30s as measured with Transtelephonic Monitoring and Standard of Care arrhythmia monitoring during a 3-12 month follow-up period post-ablation.

Time frame: 1 year follow-up post-ablation

Incidence of PV Stenosis (number of PVs with a reduction in diameter ≥ 50% at 6 months compared to baseline per CT or MRI)

Time frame: at 6 months post-ablation

Total procedure time

Time frame: at the time of the initial ablation procedure

Secondary Outcomes

Acute procedural success

Measured by the number (%) of subjects with confirmed entrance block at the end of the ablation procedure

Time frame: at the time of the initial ablation procedure

Repeat ablation procedures for AF/AT recurrences

Measured by % of subjects undergoing repeat ablation procedures for Recurring AF/AT

Time frame: through 3-12 month follow-up period post-ablation

Freedom from documented AF/AT recurrences without AAD(s)

Measured by % achieving freedom from documented AF/AT recurrences

Time frame: through 3-12 month follow-up period post-ablation

Freedom from documented AF/AT recurrences with AAD(s)

Measured by % achieving freedom from documented AF/AT recurrences

Time frame: through 3-12 month follow-up period post-ablation

Data from ClinicalTrials.gov

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