Ablation vs Drug Therapy for Atrial Fibrillation - Pilot Trial

NCT ID: NCT00578617

Last Updated: 2013-01-04

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2006-09-30

Study Completion Date

2010-06-30

Brief Summary

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The CABANA pilot study is designed to test the hypothesis that the treatment strategy of percutaneous left atrial catheter ablation for the purpose of the elimination of atrial fibrillation (AF) is superior to current state-of-the-art therapy with either rate control or anti-arrhythmic drugs for reducing AF recurrences at 1 year follow-up.

Detailed Description

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The need for this trial arises out of 1) the rapidly increasing number of pts \> 60 years of age with AF accompanied by symptoms and morbidity, 2) the failure of anti-arrhythmic drug therapy to maintain sinus rhythm and reduce mortality, 3) the rapidly increasing application of radio-frequency catheter ablation without appropriate evidence-based validation, and 4) the expanding impact of AF on health care costs.

Conditions

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Atrial Fibrillation Arrhythmia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Pharmacologic Therapy

Pharmacologic Therapy Rate and/or Sinus Rhythm Control: Patients without other heart disease will receive beta or calcium channel blockers as first line rate control therapy. Patients with underlying coronary artery disease will receive beta-blockers, patients with limited ventricular hypertrophy not warranting exclusion would receive either beta- or calcium channel blockers, while patients with heart failure would be expected to receive carvedilol or metoprolol. Patients randomized to drug therapy may be started on a membrane active drug, in an approach consistent with the recommended Guidelines for Management of Subjects with AF. Each patient will be placed on an anti-arrhythmic drug for an appropriate period and the patient cardioverted to sinus rhythm if necessary. Patients will then be followed for a period of up to 3 months, during which dosage adjustment can be made or the drug replaced with a different anti-arrhythmic drug.

Group Type ACTIVE_COMPARATOR

Rate Control

Intervention Type DRUG

Metoprolol 50-100mg

Rate Control

Intervention Type DRUG

Atenolol 50-100mg,

Rate control

Intervention Type DRUG

Propranolol 40-80mg

Rate control

Intervention Type DRUG

Acebutolol 200mg

Rate control

Intervention Type DRUG

Carvedilol 6.25mg

Rate Control

Intervention Type DRUG

Diltiazem 180-240mg

Rate Control

Intervention Type DRUG

Verapamil 180-240mg

Rate Control

Intervention Type DRUG

Digoxin 0.125mg

Rhythm Control

Intervention Type DRUG

Propafenone 450mg

Rhythm control

Intervention Type DRUG

Flecainide 200mg

Rhythm control

Intervention Type DRUG

Sotalol 240mg

Rhythm control

Intervention Type DRUG

Dofetilide 500mcg

Rhythm control

Intervention Type DRUG

Amiodarone 200mg

Rhythm control

Intervention Type DRUG

Quinidine 600-900mg

Ablation Therapy

Left Atrial Catheter Ablation: The specific choice of ablation catheters will be left to the investigator from the following list: Lifewire TC XLS, Therapy Dual/Thermocouple, NAVI-STAR/NAVI-STAR DS, Celsius Braided Tip, NAVI-STAR Thermo-Cool, Freezor/FreezorMax, Stinger, Blazer II RF/RPM/SteeroCath /XP, Chilli Cooled.

Group Type ACTIVE_COMPARATOR

Ablation Therapy

Intervention Type DEVICE

Interventions

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Rate Control

Metoprolol 50-100mg

Intervention Type DRUG

Ablation Therapy

Intervention Type DEVICE

Rate Control

Atenolol 50-100mg,

Intervention Type DRUG

Rate control

Propranolol 40-80mg

Intervention Type DRUG

Rate control

Acebutolol 200mg

Intervention Type DRUG

Rate control

Carvedilol 6.25mg

Intervention Type DRUG

Rate Control

Diltiazem 180-240mg

Intervention Type DRUG

Rate Control

Verapamil 180-240mg

Intervention Type DRUG

Rate Control

Digoxin 0.125mg

Intervention Type DRUG

Rhythm Control

Propafenone 450mg

Intervention Type DRUG

Rhythm control

Flecainide 200mg

Intervention Type DRUG

Rhythm control

Sotalol 240mg

Intervention Type DRUG

Rhythm control

Dofetilide 500mcg

Intervention Type DRUG

Rhythm control

Amiodarone 200mg

Intervention Type DRUG

Rhythm control

Quinidine 600-900mg

Intervention Type DRUG

Other Intervention Names

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Toprol St. Jude: Livewire Tenormin Inderal Sectral Coreg Cardizem Calan Lanoxin Rhythmol Tambacor Betapace Tykosin Cordarone Quini-glute/dex

Eligibility Criteria

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Inclusion Criteria

* Have documented AF, which warrants active drug or ablative treatment
* Be eligible for both catheter ablation and at least 2 sequential anti-arrhythmic drugs and/or 3 sequential rate control drugs
* Be \>65 yrs of age, or \<65 yrs with one or more of the following risk factors for stroke: Hypertension, Diabetes, Congestive heart failure (including systolic or diastolic heart failure), Prior stroke or transient ischemic attack, Left atrium \>4.5 cm, ejection fraction \<35% by echocardiogram, radionuclide evaluation or contrast ventriculography

Exclusion Criteria

* Previously failed 2 or more membrane active anti-arrhythmic drugs
* Efficacy failure of a full dose Amiodarone trial of \>12 weeks duration
* Any amiodarone therapy in the past three months
* Reversible causes of AF including thyroid disorders, acute alcohol intoxication, recent major surgical procedures, or trauma
* Lone atrial fibrillation in the absence of risk factors for stroke in patients \<65 years of age
* Recent cardiac events including myocardial infarction, percutaneous intervention, or valve or coronary bypass surgery in the preceding 3 months
* Hypertrophic obstructive cardiomyopathy
* Class IV angina or congestive heart failure
* Planned heart transplantation
* Other mandated anti-arrhythmic drug therapy
* Heritable arrhythmias or increased risk for "torsade de pointes" (a specific, rare variety of ventricular tachycardia) with class I or III drugs
* Prior left atrial catheter ablation with the intention to treat AF
* Patients with other arrhythmias requiring ablative therapy
* Prior surgical interventions for AF such as the MAZE procedure
* Prior atrioventricular nodal ablation
* Medical conditions limiting expected survival to \<1 year
* Contraindication to warfarin anti-coagulation
* Women of childbearing potential
* Participation in any other clinical mortality trial
* Unable to give informed consent
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Duke Clinical Research Institute

OTHER

Sponsor Role collaborator

Abbott Medical Devices

INDUSTRY

Sponsor Role collaborator

Mayo Clinic

OTHER

Sponsor Role lead

Responsible Party

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Mayo Clinic

Principal Investigators

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Douglas L. Packer, M.D.

Role: PRINCIPAL_INVESTIGATOR

Mayo Clinic

Locations

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Universtity of Alabama Hospital

Birminham, Alabama, United States

Site Status

Good Samaritan Hospital

Los Angeles, California, United States

Site Status

Loyola University

Maywood, Illinois, United States

Site Status

Mercy Medical Center

Des Moines, Iowa, United States

Site Status

Johns Hopkins Hospital

Baltimore, Maryland, United States

Site Status

Brigham and Womens Hospital

Boston, Massachusetts, United States

Site Status

Mayo Clinic

Rochester, Minnesota, United States

Site Status

Ohio State University Medical Center

Columbus, Ohio, United States

Site Status

University of Pennsylvania Health

Philadelphia, Pennsylvania, United States

Site Status

Intermountain Medical Center

Murray, Utah, United States

Site Status

Countries

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United States

References

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Cleland JG, Coletta AP, Buga L, Ahmed D, Clark AL. Clinical trials update from the American College of Cardiology meeting 2010: DOSE, ASPIRE, CONNECT, STICH, STOP-AF, CABANA, RACE II, EVEREST II, ACCORD, and NAVIGATOR. Eur J Heart Fail. 2010 Jun;12(6):623-9. doi: 10.1093/eurjhf/hfq083.

Reference Type BACKGROUND
PMID: 20498271 (View on PubMed)

Other Identifiers

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06-003867

Identifier Type: -

Identifier Source: org_study_id

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