Convergent Ablation Plus Left Atrial Appendage Isolation for the Treatment of Persistent Atrial Fibrillation

NCT ID: NCT06165510

Last Updated: 2025-05-13

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

RECRUITING

Clinical Phase

NA

Total Enrollment

48 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-08-02

Study Completion Date

2026-10-31

Brief Summary

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A randomised controlled clinical trial to assess efficacy of convergent ablation with the LARIAT procedure, as compared to standard endocardial catheter ablation in patients with long-standing persistent atrial fibrillation (AF).

Detailed Description

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Atrial Fibrillation is the commonest arrhythmia and is a major cause of morbidity and mortality, often causative in ischaemic strokes and compounded by heart failure. Treatment options are limited for persistent long-standing AF (PeAF), with pulmonary vein isolation by endocardial ablation being insufficient and further additive endocardial lesions with repeated ablations yield mixed results resultant in further atrial arrhythmias. Currently success rates for catheter ablation are moderate at 40 to 70% in a single procedure.

If this was improved, patient quality of life and readmission rates would significantly improve as well as a reduction in anti-arrhythmic drug use.

The Convergent procedure - is a two stage minimally invasive hybrid approach. The first stage employs surgical ablation to the posterior wall of the left atrium in combination with the LARIAT procedure to isolate the left atrium appendage (LAA). The second stage involves endocardial catheter ablation to confirm the surgical ablation lesions, and perform further endocardial catheter ablation to leverage both epicardial and endocardial lesions to create durable, transmural lesions.

Patients with long-standing persistent AF will be randomised in a 1:1 ratio to either the Convergent ablation with the LARIAT procedure or the standard endocardial catheter ablation.

This feasibility study would assess recruitment to the trial, safety and efficacy of the Convergent procedure, in combination with a left atrial appendage system.

Conditions

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Persistent Atrial Fibrillation Atrial Fibrillation, Persistent Atrium; Fibrillation Atrial Arrhythmia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Clinical study with 1:1 recruitment in each arm - Convergent AF Ablation with LARIAT procedure versus endocardial catheter ablation.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Convergent AF Ablation with Left Atrial Appendage Exclusion

Two Staged Convergent AF Ablation Procedure

Stage 1 - Minimally Invasive Surgical Epicardial Ablation Procedure with concomitant LAA exclusion (LARIAT procedure)

Stage 2 - Percutaneous Endocardial Catheter Ablation

Group Type EXPERIMENTAL

Epicardial AF ablation using AtriCure EPi-Sense-AF Guided Coagulation System with Left Atrial Appendage Exclusion using the AtriCure LARIAT Suture Delivery Device.

Intervention Type DEVICE

2 stage procedure - minimally-invasive epicardial ablation with left atrial appendage exclusion using LARIAT procedure via a subxiphoid incision. This is then combined with endocardial radiofrequency catheter ablation in a separate staged procedure.

Standard Endocardial Catheter Ablation

Intervention Type PROCEDURE

Standard percutaneous endocardial catheter ablation of atrial fibrillation

Standard Endocardial Catheter Ablation

Standard Endocardial Catheter Ablation

Group Type ACTIVE_COMPARATOR

Standard Endocardial Catheter Ablation

Intervention Type PROCEDURE

Standard percutaneous endocardial catheter ablation of atrial fibrillation

Interventions

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Epicardial AF ablation using AtriCure EPi-Sense-AF Guided Coagulation System with Left Atrial Appendage Exclusion using the AtriCure LARIAT Suture Delivery Device.

2 stage procedure - minimally-invasive epicardial ablation with left atrial appendage exclusion using LARIAT procedure via a subxiphoid incision. This is then combined with endocardial radiofrequency catheter ablation in a separate staged procedure.

Intervention Type DEVICE

Standard Endocardial Catheter Ablation

Standard percutaneous endocardial catheter ablation of atrial fibrillation

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Age \> 18 years; \< 80 years
* Persistent AF \> 1-year duration
* Left atrium size \< 6cm
* Pts should be able to provide written informed consent.

Exclusion Criteria

* Subjects currently enrolled in another investigational study except in case of observational registry with no associated treatments.
* Subject has a reversible cause of AF or transient AF
* Subject is absent of LAA or if the LAA is previously surgically ligated
* Subject has had previous cardiac surgery or abdominal surgery.
* Subject has contraindication to anticoagulation.
* Patients with hypertrophic cardiomyopathy.
* Patients with significant valve disease.
* Subject has had previous catheter or surgical ablation
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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AtriCure, Inc.

INDUSTRY

Sponsor Role collaborator

Barts & The London NHS Trust

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Syed Ahsan

Role: PRINCIPAL_INVESTIGATOR

Consultant Cardiologist and Electrophysiologist, Barts Health NHS Trust

Locations

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St Bartholomew's Hospital

London, , United Kingdom

Site Status RECRUITING

Countries

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United Kingdom

Central Contacts

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Syed Ahsan

Role: CONTACT

020 7377 7000

Shahana Hussain

Role: CONTACT

020 7377 7000

Facility Contacts

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Syed Ahsan

Role: primary

020 7377 7000

Other Identifiers

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320553

Identifier Type: -

Identifier Source: org_study_id

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