FIRE AND ICE: Comparative Study of Two Ablation Procedures in Patients With Atrial Fibrillation

NCT ID: NCT01490814

Last Updated: 2018-11-02

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

769 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-12-31

Study Completion Date

2016-01-31

Brief Summary

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Comparing efficacy and safety of isolation of the pulmonary veins (PV) using a Cryoballoon catheter versus a radiofrequency ablation with a ThermoCool catheter in patients with paroxysmal atrial fibrillation.

Detailed Description

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The purpose of this randomized clinical trial is to compare the efficacy and safety of isolating the PVs with either the cryoballoon or a RF ablation technique with a ThermoCool catheter, a system which can be regarded as standard for ablation. In total 762 patients with paroxysmal atrial fibrillation has been randomized for either radiofrequency (RF) or cryoballoon. With both techniques, PV isolation will be performed. Primary end point of the trial is the time to first recurrence of atrial arrhythmias or prescription of anti-arrhythmic drugs after a blanking period of three months. Treatment success will be evaluated by using weekly electrocardiography (ECG) monitoring (transtelephonic transmission/Tele-ECG) and using Holter electrocardiograms.

Conditions

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Symptomatic Paroxysmal Atrial Fibrillation (PAF)

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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Cryoballoon ablation

Group Type ACTIVE_COMPARATOR

Electrical isolation of the pulmonary veins

Intervention Type PROCEDURE

Device: ArcticFront® Cardiac CryoAblation Catheter System with the FlexCath Steerable Sheath or ArcticFront® Advance Cardiac CryoAblation Catheter System with the FlexCath Steerable Sheath or any future development generations of this product line, provided they are CE marked and the centre has the experience of at least 10 procedures before including a patient into the study.

Radiofrequency ablation

Group Type ACTIVE_COMPARATOR

Electrical isolation of pulmonary veins

Intervention Type PROCEDURE

Device:NaviStar® ThermoCool® Irrigated Tip Ablation Catheter in combination with 3D mapping system CARTO or any future development generations of this product line, provided they are CE marked and the centre has the experience of at least 10 procedures before including a patient into the study.

Interventions

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Electrical isolation of the pulmonary veins

Device: ArcticFront® Cardiac CryoAblation Catheter System with the FlexCath Steerable Sheath or ArcticFront® Advance Cardiac CryoAblation Catheter System with the FlexCath Steerable Sheath or any future development generations of this product line, provided they are CE marked and the centre has the experience of at least 10 procedures before including a patient into the study.

Intervention Type PROCEDURE

Electrical isolation of pulmonary veins

Device:NaviStar® ThermoCool® Irrigated Tip Ablation Catheter in combination with 3D mapping system CARTO or any future development generations of this product line, provided they are CE marked and the centre has the experience of at least 10 procedures before including a patient into the study.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Symptomatic PAF with at least two episodes and at least one episode documented (30 seconds episode length, documented by ECG within last 12 months).
* Documented treatment failure for effectiveness of at least one anti-arrhythmic drug(AAD Type I or III, including β-blocker and AAD intolerance).
* ≥ 18 and ≤ 75 years of age.
* Patients who are mentally and linguistically able to understand the aim of the trial and to show sufficient compliance in following the trial protocol.
* Patient is able to verbally acknowledge and understand the associated risks, benefits, and treatment alternatives to therapeutic options of this trial: cryoballoon ablation system or standard RF ablation technique. The patients, by providing informed consent, agree to these risks and benefits as stated in the patient informed consent document. All the details have been presented to him and he has signed the informed consent form for the trial.

Exclusion Criteria

* Any disease that limits life expectancy to less than one year.
* Participation in another clinical trial (of a drug, device or biologic), either within the past two months or ongoing.
* Pregnant women or women of childbearing potential not on adequate birth control: only women with a highly effective method of contraception \[oral contraception or intrauterine device (IUD)\] or sterile women can be randomized.
* Breastfeeding women.
* Substance misuse.
* Active systemic infection.
* Cryoglobulinaemia.
* Previous participation in this clinical trial.
* Employment by the sponsor or by the department of any of the investigators.
* Close relatives of any of the investigators.


* Patients with prosthetic valves.
* Any previous LA ablation or surgery.
* Any cardiac surgery or percutaneous coronary intervention (PCI) within three months prior to enrollment.
* Unstable angina pectoris.
* Myocardial infarction within three months prior to enrollment.
* Symptomatic carotid stenosis.
* Chronic obstructive pulmonary disease with detected pulmonary hypertension.
* Any condition contraindicating chronic anticoagulation.
* Stroke or transient ischemic attack within six months prior to enrollment.
* Any significant congenital heart defect corrected or not (including atrial septal defects or PV abnormalities) but not including patent foramen ovale.
* New York Heart Association (NYHA) class III or IV congestive heart failure.
* EF \< 35 % (determined by echocardiography within 60 days of enrollment as documented in patient medical history).
* Anteroposterior LA diameter \> 55 mm (by trans-thoracic echocardiography (TTE or TEE) within three months to prior enrollment).
* LA thrombus (TEE diagnostic performed on admission).
* Intracardiac thrombus.
* PV diameter \> 26 mm in right sided PVs.
* Mitral prosthesis.
* Hypertrophic cardiomyopathy (see Appendix IX)
* 2° (Type II) or 3° atrioventricular block.
* Brugada syndrome or long QT syndrome.
* Arrhythmogenic right ventricular dysplasia.
* Sarcoidosis.
* PV stent.
* Myxoma.


* Thrombocytosis (platelet count \> 600,000 / µl), thrombocytopenia (platelet count \< 100,000 / µl).
* Any untreated or uncontrolled hyperthyroidism or hypothyroidism.
* Severe renal dysfunction (stage V, requiring or almost requiring dialysis, glomerular filtration rate (GFR) \< 15 ml / min).
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Medtronic

INDUSTRY

Sponsor Role collaborator

Medtronic Atrial Fibrillation Solutions

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Karl-Heinz Kuck, Prof. Dr.

Role: PRINCIPAL_INVESTIGATOR

Asklepios Klinikum St. Georg

Locations

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Na Homolce Hospital, Cardiology

Prague, , Czechia

Site Status

Hospital Henri Mondor CHU, Service de Cardiologie

Créteil, , France

Site Status

CHU Lyon, Départment de Rythmologie, Hospital Cardiologique Pradel

Lyon, , France

Site Status

Centre Chirurgical Ambroise Paré

Neuilly-sur-Seine, , France

Site Status

La Clinique Pasteur, 45 Avenue de Lombez

Toulouse, , France

Site Status

Herz-Zentrum Bad Krozingen

Bad Krozingen, , Germany

Site Status

Klinik für Kardiologie II mit interventioneller Elektrophysiologie

Bad Neustadt/Saale, , Germany

Site Status

Cardioangiologisches Centrum Bethanien - CCB

Frankfurt, , Germany

Site Status

Universitätsklinikum Greifswald Elektrophysiologie

Greifswald, , Germany

Site Status

Asklepios Klinik St. Georg

Hamburg, , Germany

Site Status

Herz-Zentrum-Bodensee Konstanz

Konstanz, , Germany

Site Status

Semmelweis University of Medicine, Kardiovaskuläres Zentrum

Budapest, , Hungary

Site Status

Cardiac Arrhythmia Research Centre Department of Cardiovascular Medicine Centro Cardiologico Monzino University of Milan

Milan, , Italy

Site Status

Isala Klinieken loc. Weezenlanden Diagram Clinical Resarch

Zwolle, , Netherlands

Site Status

Hospital Clinic, University of Barcelona

Barcelona, , Spain

Site Status

Arrhythmia Unit Hospital Clinico San Carlos

Madrid, , Spain

Site Status

Hospital Universitario Virgen de la Victoria, Department of Cardiology, Campus Teatinos sn

Málaga, , Spain

Site Status

Hospital Clinico Universtitario, Cardiology Department Arrhythmia Unit

Valencia, , Spain

Site Status

Universitätsspital Basel, Elektrophysiologie/ Kardiologie

Basel, , Switzerland

Site Status

Countries

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Czechia France Germany Hungary Italy Netherlands Spain Switzerland

References

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Furnkranz A, Brugada J, Albenque JP, Tondo C, Bestehorn K, Wegscheider K, Ouyang F, Kuck KH. Rationale and Design of FIRE AND ICE: A multicenter randomized trial comparing efficacy and safety of pulmonary vein isolation using a cryoballoon versus radiofrequency ablation with 3D-reconstruction. J Cardiovasc Electrophysiol. 2014 Dec;25(12):1314-20. doi: 10.1111/jce.12529. Epub 2014 Nov 12.

Reference Type BACKGROUND
PMID: 25146732 (View on PubMed)

Kuck KH, Brugada J, Furnkranz A, Metzner A, Ouyang F, Chun KR, Elvan A, Arentz T, Bestehorn K, Pocock SJ, Albenque JP, Tondo C; FIRE AND ICE Investigators. Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. N Engl J Med. 2016 Jun 9;374(23):2235-45. doi: 10.1056/NEJMoa1602014. Epub 2016 Apr 4.

Reference Type RESULT
PMID: 27042964 (View on PubMed)

Huang C, Wang J, He C, Yang K, Zhao H, Chen J, Su L. The Efficacy and Safety of Cryoballoon Versus Radiofrequency Ablation for the Treatment of Atrial Fibrillation: A Meta-Analysis of 15 International Randomized Trials. Cardiol Rev. 2024 Nov-Dec 01;32(6):546-553. doi: 10.1097/CRD.0000000000000531. Epub 2024 Oct 4.

Reference Type DERIVED
PMID: 37071112 (View on PubMed)

Kuck KH, Brugada J, Furnkranz A, Chun KRJ, Metzner A, Ouyang F, Schluter M, Elvan A, Braegelmann KM, Kueffer FJ, Arentz T, Albenque JP, Kuhne M, Sticherling C, Tondo C; FIRE AND ICE Investigators. Impact of Female Sex on Clinical Outcomes in the FIRE AND ICE Trial of Catheter Ablation for Atrial Fibrillation. Circ Arrhythm Electrophysiol. 2018 May;11(5):e006204. doi: 10.1161/CIRCEP.118.006204.

Reference Type DERIVED
PMID: 29700058 (View on PubMed)

Chun KRJ, Brugada J, Elvan A, Geller L, Busch M, Barrera A, Schilling RJ, Reynolds MR, Hokanson RB, Holbrook R, Brown B, Schluter M, Kuck KH; FIRE AND ICE Investigators. The Impact of Cryoballoon Versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation on Healthcare Utilization and Costs: An Economic Analysis From the FIRE AND ICE Trial. J Am Heart Assoc. 2017 Jul 27;6(8):e006043. doi: 10.1161/JAHA.117.006043.

Reference Type DERIVED
PMID: 28751544 (View on PubMed)

Kuck KH, Furnkranz A, Chun KR, Metzner A, Ouyang F, Schluter M, Elvan A, Lim HW, Kueffer FJ, Arentz T, Albenque JP, Tondo C, Kuhne M, Sticherling C, Brugada J; FIRE AND ICE Investigators. Cryoballoon or radiofrequency ablation for symptomatic paroxysmal atrial fibrillation: reintervention, rehospitalization, and quality-of-life outcomes in the FIRE AND ICE trial. Eur Heart J. 2016 Oct 7;37(38):2858-2865. doi: 10.1093/eurheartj/ehw285. Epub 2016 Jul 5.

Reference Type DERIVED
PMID: 27381589 (View on PubMed)

Luik A, Radzewitz A, Kieser M, Walter M, Bramlage P, Hormann P, Schmidt K, Horn N, Brinkmeier-Theofanopoulou M, Kunzmann K, Riexinger T, Schymik G, Merkel M, Schmitt C. Cryoballoon Versus Open Irrigated Radiofrequency Ablation in Patients With Paroxysmal Atrial Fibrillation: The Prospective, Randomized, Controlled, Noninferiority FreezeAF Study. Circulation. 2015 Oct 6;132(14):1311-9. doi: 10.1161/CIRCULATIONAHA.115.016871. Epub 2015 Aug 17.

Reference Type DERIVED
PMID: 26283655 (View on PubMed)

Related Links

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http://www.ncbi.nlm.nih.gov/pubmed/25146732

Rationale and Design of FIRE AND ICE: A Multicenter Randomized Trial Comparing Efficacy and Safety of Pulmonary Vein Isolation using a Cryoballoon Versus Radiofrequency Ablation with 3D-reconstruction.

http://www.ncbi.nlm.nih.gov/pubmed/27042964

Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation.

Other Identifiers

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FI-123

Identifier Type: -

Identifier Source: org_study_id

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