Symptomatic Paroxysmal Atrial Fibrillation Without Clinically Significant Heart Diseases
Conditions
Keywords
paroxysmal Atrial Fibrillation, Cryoablation, Pulmonary Vein Isolation
Brief summary
The purpose of this study is to evaluate the effectiveness of Pulmonary Vein Isolation (PVI) performed with the Arctic Front™ Advance Cardiac CryoAblation Catheter System as first-line therapy in comparison with antiarrhythmic drugs (AAD) in patients with paroxysmal atrial fibrillation (AF).
Interventions
AAD therapy based on hospital clinical practice according to ESC Guidelines 2012
Sponsors
Medtronic Cardiac Ablation Solutions
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Subject has been diagnosed with symptomatic paroxysmal atrial fibrillation as defined above and at least two symptomatic episodes in the last six months prior to inclusion. * At least one episode of AF must be documented during the prior year by any kind of ECG recording. * Subject has structural normal heart with an LVEF ≥ 50%, thickness of the inter-ventricular septum ≤12 mm and left atrium diameters (short axis) \< 46 mm obtained by transthoracic echocardiography. * Subject has normal ECG parameters (QRS width in the 12 channel surface ECG ≤120 ms, QTc - interval \< 440 ms, PQ - interval ≤ 210 ms; all parameters should be measured at sinus rhythm). * Subject is at least 18 and not older than 75years old. * Subject is able and willing to give informed consent.
Exclusion criteria
* Subject developed persistent AF at least once in history (electrical or pharmacological cardioversion after 48h or episode duration \>7 days). * Subject has documented typical atrial flutter. * Subject has any history of successful or unsuccessful treatment of AF with class I or III antiarrhythmic or sotalol with the intention to prevent an AF recurrence. Patients pretreated with above AAD at maximum 48 hours with the intention to convert an AF episode are allowed. * Subject had any previous left atrial ablation. * Subject had any previous cardiac surgery, e.g. prosthetic valves. * Subject has permanent pacemaker or defibrillator implant. * Subject has 2° type II, 3° degree AV-block or left/right bundle branch block pattern. * Subject has unstable angina pectoris. * Subject has history of previous myocardial infarction or percutaneous intervention during the last three months. * Subject has symptomatic carotid stenosis. * Subject has chronic obstructive pulmonary disease with detected pulmonary hypertension or any other evidence of significant lung disease. * Subject has any contraindication for oral anticoagulation. * Subject has any history of previous transient ischemic attack or stroke. * Subject has known intra-cardiac thrombus formation. * Subject has any significant congenital heart defect corrected or not (except for patent foramen ovale that is allowed). * Subject has evidence of congestive heart failure (NYHA class II, III or IV) in sinus rhythm. * Subject has hypertrophic cardiomyopathy. * Subject has abnormal long or short QT interval, signs of Brugada syndrome, known inheriting ion channel disease on the family, arrhythmogenic right ventricular dysplasia. * Subject has sarcoidosis. * Subject has pulmonary vein stent. * Subject has myxoma.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Freedom from any atrial arrhythmia recurrence | 12 months | The primary endpoint is freedom from any atrial arrhythmia recurrence at 12 months (at least one episode of AF, atrial flutter or atrial tachycardia with a duration \> 30 seconds documented by 7 day Holter ECG or any other printed ECG recording following a blanking period or a dosing optimizing period of 3 months). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hospital or emergency services accesses | 12 Months | Hospital or emergency services accesses due to symptoms caused by documented atrial arrhythmias will be compared in the two arms at 12 months follow-up. |
| Freedom from occurrence of AF | 12 months | Freedom from occurrence of AF (after 3 months blanking period) will be compared between the two arms at 12 months follow-up. |
| Freedom from occurrence of documented left atrial tachycardia and left atrial flutter | 12 months | Freedom from occurrence of documented left atrial tachycardia and typical - or atypical left atrial flutter (after 3 months blanking period or AAD optimization period) will be compared between the two arms at 12 months follow-up. |
| Symptomatic palpitations burden | 12 months | Symptomatic palpitations burden will be evaluated by mean of Patient's diary information and compared between the two arms at 12 months follow-up. |
| quality of life | 12 months | The quality of life of the two arms measured by means of SF-36 Health Survey and Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) questionnaires will be compared at 12 months follow-up. |
| Freedom from persistent AF | 12 months | Freedom from persistent AF (AF episode lasting longer than 7 days or interrupted by pharmacological or electrical cardioversion after 48h from the onset of the episode) will be compared between the two arms at 12 months follow-up. |
| Echocardiographic left atrial re-modelling | 12 months | Echocardiographic left atrial parameters will be compared between the two arms at 6 and 12 months follow ups. |
| health care utilization | 12 months | Frequency, type and associated cost of health care utilization and utility will be compared between the two arms at 12 months follow-up. |
| Severe adverse events incidence | 12 months | Severe adverse events incidence will be compared between the two arms during the whole course of the study. |
Countries
Argentina, Australia, Belgium, Croatia, France, Germany, Italy, Netherlands, Norway
Outcome results
None listed