Left Atrial Posterior Wall and PV Isolation Using Cryoballoon for Treatment of Persistent AF

NCT ID: NCT04505163

Last Updated: 2023-09-06

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

NA

Total Enrollment

153 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-04-30

Study Completion Date

2024-12-31

Brief Summary

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The purpose of this study it to learn whether pulmonary vein isolation (PVI) along with isolation of the posterior left atrial wall (PWI) in the region of the pulmonary venous component will reduce the likelihood of atrial fibrillation (AF) recurrence in patients with persistent atrial fibrillation at 12 months, after a single ablation procedure, in comparison to PVI alone.

The investigator hypothesizes that the combination of PVI + PWI will result in a significant reduction in recurrence of atrial fibrillation at 12 months after ablation.

Detailed Description

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Patients with persistent atrial fibrillation will be enrolled in this multi-center, randomized, prospective, single-blinded study. After catheter ablation (isolation) of the pulmonary veins (PVI) and while still in the cardiac electrophysiology laboratory, all patients will be randomized to either PVI alone or the combination of PVI + posterior left atrial wall isolation (PWI). For patients randomized to PVI, their ablation procedure will be completed at that time. For those patients randomized to PVI + PWI, they will have additional ablation to achieve PWI.

All study patients will have the same follow-up after their ablation procedure, including clinic visits at 3, 6, and 12 months and a heart event monitor for 7-14 days before these visits. An echocardiogram (heart ultrasound) is performed at 6 to 12 months after the ablation. Blood thinners are recommended for two months after ablation and then the need for continued use of blood thinners will be based on individual patient's medical history, stroke risk and the decision of the study doctor. Information about the patients' medical history, heart arrhythmias and atrial fibrillation will be collected during the study which will be analyzed.

Conditions

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Persistent Atrial Fibrillation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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Standard Cryoballoon Pulmonary Vein Isolation (PVI)

Standard cryoballoon pulmonary vein isolation alone using the Arctic Front Advance Cryoablation System family of cardiac ablation catheters

Group Type ACTIVE_COMPARATOR

Standard Cryoballoon Pulmonary Vein Isolation (PVI)

Intervention Type PROCEDURE

Arctic Front Advance cryoballoon ablation system to ablate the pulmonary veins to achieve PVI alone

Cryoballoon PVI + Posterior Wall Isolation

Cryoballoon pulmonary vein isolation in conjunction with posterior wall isolation using the Arctic Front Advance Cryoablation System family of cardiac ablation catheters

Group Type EXPERIMENTAL

Cryoballoon PVI + Posterior Wall Isolation

Intervention Type DEVICE

Arctic Front Advance Cardiac Cryoballoon Ablation System to ablate the pulmonary veins and the left atrial posterior wall to achieve PVI + posterior wall isolation within the region of the pulmonary venous component

Interventions

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Standard Cryoballoon Pulmonary Vein Isolation (PVI)

Arctic Front Advance cryoballoon ablation system to ablate the pulmonary veins to achieve PVI alone

Intervention Type PROCEDURE

Cryoballoon PVI + Posterior Wall Isolation

Arctic Front Advance Cardiac Cryoballoon Ablation System to ablate the pulmonary veins and the left atrial posterior wall to achieve PVI + posterior wall isolation within the region of the pulmonary venous component

Intervention Type DEVICE

Other Intervention Names

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Arctic Front Advance Cardiac Cryoablation System Arctic Front Advance Cardiac Cryoablation System

Eligibility Criteria

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Inclusion Criteria

* Consistent with the current definitions, all patients with Persistent AF must exhibit an episode of continuous AF that is sustained \>7 days.
* Patients must have symptomatic Persistent AF refractory or intolerant to at least one class I or class III antiarrhythmic drug
* Males and females with an age \>18 years undergoing a first-time catheter ablation of AF; prior ablation of a right atrial cardiac arrhythmia (i.e., typical right atrial flutter) is permitted
* All patients must understand the requirements of the study and be willing to comply with the post-study follow-up requirements
* Patients must have documented episode of AF greater than 7 days in the year prior to the procedure

Exclusion Criteria

* History of long-standing persistent AF
* Any reversible cause of AF (post-operative, thyroid disorder, etc.)
* Patients with cerebral ischemic events (stroke or transient ischemic attack), myocardial infarction or unstable angina in the previous 2 months
* Patients with any corrected or uncorrected congenital heart disease
* Patients with a history of hypertrophic cardiomyopathy
* Patients with cardiomyopathy and a left ventricular ejection fraction \<40%
* Congestive heart failure, class IV
* Left atrial (LA) diameter \>55 mm (parasternal long axis view)
* Patients with left atrial thrombus
* Women who are known to be pregnant or have had a positive β-HCG (human chorionic gonadotropin) test 7 days prior to procedure
* Patients whose life expectancy is \<1 year
* History of left-sided left atrial ablation (catheter or surgically-based)
* Mental impairment precluding the patient from providing informed consent or completing appropriate follow-up
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Mercy General Hospital and Dignity Health Medical Foundation

UNKNOWN

Sponsor Role collaborator

Beth Israel Deaconess Medical Center

OTHER

Sponsor Role collaborator

UC Health Medical Center

UNKNOWN

Sponsor Role collaborator

MedStar Georgetown University Hospital and Medical Center

UNKNOWN

Sponsor Role collaborator

Tampa Cardiac Specialists

UNKNOWN

Sponsor Role collaborator

Bethesda North Hospital

UNKNOWN

Sponsor Role collaborator

Brigham and Women's Hospital

OTHER

Sponsor Role collaborator

Texas Cardiac Arrhythmia Institute At St. Davids Medical Center

UNKNOWN

Sponsor Role collaborator

St. Luke's Hospital and Health Network, Pennsylvania

OTHER

Sponsor Role collaborator

Sarasota Memorial Health Care System

OTHER

Sponsor Role collaborator

Nebraska Methodist Hospital-Methodist Physicians Clinic

UNKNOWN

Sponsor Role collaborator

Dignity Health Medical Foundation

OTHER

Sponsor Role lead

Responsible Party

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Arash Aryana, MD

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Arash Aryana, MD

Role: PRINCIPAL_INVESTIGATOR

Mercy General Hospital and Dignity Health Medical Foundation

Locations

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Mercy General Hospital and Dignity Health Medical Foundation

Sacramento, California, United States

Site Status

UCHealth Medical Center

Fort Collins, Colorado, United States

Site Status

MedStar Georgetown University Hospital and Medical Center

Washington D.C., District of Columbia, United States

Site Status

Sarasota Memorial Health Care System

Sarasota, Florida, United States

Site Status

Tampa Cardiac Specialists

Tampa, Florida, United States

Site Status

Brigham and Women's Hospital

Boston, Massachusetts, United States

Site Status

Beth Israel Deaconess Medical Center

Boston, Massachusetts, United States

Site Status

Nebraska Methodist Hospital-Methodist Physicians Clinic

Omaha, Nebraska, United States

Site Status

Bethesda North Hospital

Cincinnati, Ohio, United States

Site Status

St. Luke's University Health Network

Bethlehem, Pennsylvania, United States

Site Status

Texas Cardiac Arrhythmia Institute & St. David's Medical Center

Austin, Texas, United States

Site Status

Countries

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United States

References

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Aryana A, Pujara DK, Allen SL, Baker JH, Espinosa MA, Buch EF, Srivatsa U, Ellis E, Makati K, Kowalski M, Lee S, Tadros T, Baykaner T, Al-Ahmad A, d'Avila A, Di Biase L, Okishige K, Natale A. Left atrial posterior wall isolation in conjunction with pulmonary vein isolation using cryoballoon for treatment of persistent atrial fibrillation (PIVoTAL): study rationale and design. J Interv Card Electrophysiol. 2021 Oct;62(1):187-198. doi: 10.1007/s10840-020-00885-w. Epub 2020 Oct 3.

Reference Type DERIVED
PMID: 33009645 (View on PubMed)

Other Identifiers

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PIVoTAL-IDE

Identifier Type: -

Identifier Source: org_study_id

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