Efficiency Study Evaluating the Use of PVAC Catheter Technology for Performing Ablation in Pts With Atrial Fibrillation

NCT01562912 | Completed

• 1 other identifier: NERG-01
• Study Type: interventional
• Target: 230
• Locations: 1 country
• Sites: 6

Brief Summary

Atrial fibrillation (AF) is the most common arrhythmia affecting the Canadian population. AF is associated with increased risk of stroke,HF, and even mortality. AF can cause debilitating symptoms, adversely affect patient's (pt's) quality of life and functional status. Hence a strategy of sinus rhythm (SR) may be pursued over a strategy of allowing AF to persist. Percutaneous catheter ablation is an effective alternative to antiarrhythmic drugs (AAD) for maintaining SR. The success rate of PV isolation off AAD is about 80-90% in pt's with PAF, but repeat procedures are required in up to 40% of pt's. After one ablation, the success rate may only be 50-70% off drugs.Current standard ablation procedures for PV antral isolation employ mapping systems which reconstructions of the LA and PV anatomy are created. Visualization may be supplemented by integration of CT/ MRI images and/or intracardiac echocardiography. Robotic navigation has been employed to assist in ablation. Based on single point unipolar radiofrequency (RF) ablation catheter where lesions are created point-by-point around the PVs to obtain electrical isolation.This results in lengthy complex, costly procedures,often more than 4 hours, which requires high degree of operator skill.Creation of contiguous, transmural lesions is challenging with standard single-point RF. A novel multipolar catheter ablation system has been evaluated for achieving PV isolation (PVAC catheter, Medtronic Inc.) An over-the-wire circular mapping/ablation catheter can be advanced into the PV antrum, and multiple lesions around the circumference of the catheter can be delivered simultaneously using duty-cycled unipolar and bipolar RF energy. Early reports, the system can achieve complete PV isolation with reduced fluoroscopy and procedural times using lower powers to achieve more reliable lesion sets.Long-term efficacy also seems comparable to standard RF ablation.This novel technology has potential to broaden the application of AF ablation, making procedures less time-consuming, less complex without compromising procedural efficacy. Published data PVAC technology outcomes are limited to studies with small sample sizes of 12-102 pt's. Data has been restricted to a small number of European centers performing moderate numbers of PVAC procedures. There is no prospective, multicenter data. Little is known about the efficiency of PVAC procedures, allowing for an assessment of cost-effectiveness in using this technology.

Conditions

Atrial Fibrillation

Keywords

radiofrequency; ablation; atrial fibrillation; PVAC

Outcome Measures

Primary Outcomes (1)

• Procedure Duration and Fluoroscopy time

  Length of procedure measure in hours/minutes and use of fluoroscopy measured in minutes

  At the time of the initial ablation procedure and repeat ablations.

Secondary Outcomes (3)

• Incidence of emergency room visits, hospitalizations and urgent clinic visits.

  1 year follow-up post ablation

• Quality of Life measurements (CCS-SAF, AFEQT and SF-12)

  1 year post ablation

• Total ablation procedure costs.

  1 year post ablation

Study Arms (2)

Control

ACTIVE COMPARATOR

Radiofrequency Ablation Procedure. Subjects who are undergoing AF ablation with traditional ablation technology at the same centers by the same operators. Control patients will be enrolled in a 1:2 ratio compared to the PVAC cohort. Intervention is the use of Radiofrequency Ablation.

Device: Radiofrequency Ablation Procedure

PVAC Ablation Procedure

EXPERIMENTAL

Intervention is the use of PVAC technology. The PVAC is deployed in the left atrium over a 0.032-inch guidewire inside the PV and advanced until it is wedged within the antrum proximal to the ostium. Energy is delivered through selected electrode pairs with local potentials as well as adjacent electrode pairs, allowing bipolar current to flow to the target electrode(s) from both sides. Each application lasts for 60 seconds. When the temperature does not rise above 50°C within 15 seconds, the application should be discontinued to improve position. The PVAC may be manipulated within the antrum to ablate in a pattern of overlapping circular lesions.

Device: PVAC Ablation Procedure

Interventions

Radiofrequency Ablation Procedure DEVICE

Application of radiofrequency energy will be delivered during PV antral isolation procedure and should be performed with a standard, open irrigated ablation catheter and a mapping system as the investigator would perform the procedure normally.

Also known as: THERMOCOOL Catheter, Biosense Webster, EnSite NavX Velocity, St Jude, LASSO Circular Mapping Catheter, Biosense Webster

Control

PVAC Ablation Procedure DEVICE

Application of radiofrequency energy with the Pulmonary Vein Ablation Catheter(PVAC)to eliminate potentials arising from the pulmonary veins.

Also known as: PVAC Catheter, Medtronic Inc., Ablation Frontiers

PVAC Ablation Procedure

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients aged 18 years or greater.
• Patients undergoing first-time catheter ablation for AF.
• Patients with paroxysmal AF. Paroxysmal AF will be defined as self-terminating episodes less than 7 days duration. Patients should have had at least 3 episodes of AF in a one year period.
• Patients with symptomatic AF that is refractory to at least one antiarrhythmic medication. "Symptomatic" patients are those who have been aware of their AF anytime within the last 5 years prior to enrollment. Symptoms may include, but are not restricted to, palpitations, shortness of breath, chest pain, fatigue, or any combination of the above.
• At least one episode of AF must have been documented by ECG, Holter, loop recorder, telemetry, or transtelephonic monitoring within 24 months of enrollment in the study.
• Patients must be able and willing to provide written informed consent to participate in the clinical study.

You may not qualify if:

• Patients with persistent AF (defined as an episode of AF lasting \>7 days).
• Patients with AF felt to be secondary to an obvious reversible cause.
• Patients with contraindications to systemic anticoagulation with heparin or warfarin or a direct thrombin inhibitor.
• Patients who have previously undergone AF ablation.
• Patients with left atrial size \>/= 55 mm (2D echocardiography, parasternal long axis view).
• Patients who are or may potentially be pregnant.

Sponsors & Collaborators

• Newmarket Electrophysiology Research Group Inc: lead
• Medtronic: collaborator

Study Sites (6)

Hamilton Health Sciences

Hamilton, Ontario, Canada

Location

London Health Sciences Center

London, Ontario, N6A 5A5, Canada

Location

Southlake Regional Health Centre

Newmarket, Ontario, L3Y 2P9, Canada

Location

McGill University Health Centre

Montreal, Quebec, H3G 1A4, Canada

Location

Hôpital Sacré-Coeur de Montréal

Montreal, Quebec, H4J 1C5, Canada

Location

Institut universitaire de cardiologie et de pneumologie de Québec

Québec, Quebec, G1V 4G5, Canada

Location

Related Publications (1)

• Essebag V, Azizi Z, Alipour P, Khaykin Y, Leong-Sit P, Sarrazin JF, Sturmer M, Morillo C, Terricabras M, Amit G, Roux JF, Patterson S, Verma A. Relationship between quality of life and burden of recurrent atrial fibrillation following ablation: CAPCOST multicentre cohort study. Europace. 2020 Jul 1;22(7):1017-1025. doi: 10.1093/europace/euaa066.

  PMID: 32531030 DERIVED

MeSH Terms

Conditions

Atrial Fibrillation

Condition Hierarchy (Ancestors)

Arrhythmias, Cardiac; Heart Diseases; Cardiovascular Diseases; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Atul Verma, MD

  Newmarket Electrophysiology Research Group

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 20, 2012
• First Posted: March 26, 2012
• Study Start: February 1, 2012
• Primary Completion: December 1, 2017
• Study Completion: March 1, 2018
• Last Updated: March 29, 2018

Record last verified: 2018-03

Locations

CA (6)