Comparison of Redo PVI With vs. Without Renal Denervation for Recurrent AF After Initial PVI

NCT ID: NCT01959997

Last Updated: 2015-09-23

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE2

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-09-30

Study Completion Date

2016-09-30

Brief Summary

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The objective of this study is to compare the elimination of atrial fibrillation in patients with recurrent atrial fibrillation despite prior pulmonary vein isolation (PVI) when undergoing repeat PVI (control) vs repeat PVI plus renal denervation.

Detailed Description

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Conditions

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Atrial Fibrillation Arterial Hypertension

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Redo PVI

Therapeutic anticoagulation will be required for at least 3 weeks prior to ablation. An MRA will be performed to define cardiac and PV anatomy. Standard ablation technique will be employed. After gaining venous access, double transseptal puncture will be performed to permit left atrial access, guided by intracardiac ultrasound. A circular mapping catheter will be placed in each PV and any reconnections will be ablated by delivery of RF energy. Confirmation of re-isolation of all PVs will be performed at the conclusion of the procedure.

Group Type ACTIVE_COMPARATOR

Redo PVI

Intervention Type PROCEDURE

PVI + RDN

All patients who are randomized to Group II will undergo redo PVI exactly as described above.

At the conclusion of PVI, RDN will be performed. Real-time 3-dimensional aorta-renal artery maps will be constructed with the use of the same navigation system and catheter used for PVI after femoral artery access. Both mapping and ablation will performed under the same modified sedation. RF ablations of 8 to 10 watts will be applied discretely from the first distal main renal artery bifurcation all the way back to the ostium, for 2 min, and up to 6 lesions (separated by ≥ 5 mm). Lesions will be made both longitudinally and rotationally within each renal artery. To confirm renal denervation, high-frequency stimulation (HFS) will be used before the initial and after each RF delivery within the renal artery. RDN will be considered to have been achieved when the sudden increase of blood pressure (≥ 15 mm Hg from invasive arterial monitoring) is absent.

Group Type ACTIVE_COMPARATOR

PVI + RDN

Intervention Type PROCEDURE

Interventions

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Redo PVI

Intervention Type PROCEDURE

PVI + RDN

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Prior PVI ablation procedure for paroxysmal AF within past 2 years
* Recurrent symptomatic paroxysmal AF despite prior PVI
* History of essential hypertension requiring at least 2 chronic antihypertensive medications

Exclusion Criteria

* Persistent AF after prior ablation
* Congestive heart failure (NYHA III-IV functional class)
* Left ventricle ejection fraction \< 35%
* Left atrial diameter \>55 mm
* An estimated glomerular filtration rate (eGFR) \< 45mL/min/1.73m2, using the MDRD calculation
* Renal arteries unsuitable for RDN:

1. Inability to access renal vasculature
2. Main renal arteries \< 4 mm in diameter or \< 20 mm in length.
3. Hemodynamically or anatomically significant renal artery abnormality or stenosis in either renal artery
4. A history of prior renal artery intervention including balloon angioplasty or stenting that precludes a possibility of ablation treatment
5. Multiple main renal arteries to either kidney
* Unwillingness to participate
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Meshalkin Research Institute of Pathology of Circulation

NETWORK

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jonathan S. Steinberg, MD

Role: PRINCIPAL_INVESTIGATOR

University of Rochester

Locations

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University of Rochester

Rochester, New York, United States

Site Status ACTIVE_NOT_RECRUITING

State Research Institute of Circulation Pathology

Novosibirsk, , Russia

Site Status RECRUITING

Countries

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United States Russia

Central Contacts

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Evgeny Pokushalov, MD, PhD

Role: CONTACT

+79139254858

Facility Contacts

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Evgeny Pokushalov, MD, PhD

Role: primary

+79139254858

Other Identifiers

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RD_REDO_032

Identifier Type: -

Identifier Source: org_study_id

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