Paroxysmal Atrial Fibrillation
Conditions
Brief summary
Prospective non-randomized parallel-assignment multi-center clinical investigation. The study design includes two subject cohorts: 1) Paroxysmal Atrial Fibrillation Main Study, and 2) Paroxysmal Atrial Fibrillation High Standard Power Substudy. Subjects in the main study cohorts are to be treated using the full range of ablation power settings in the Instructions For Use. Subjects in the High Standard Power Substudy are to be treated in the upper end of the recommended ablation power settings (40-50 Watts).
Detailed description
This clinical investigation is intended to demonstrate the safety and effectiveness of the TactiFlex(TM) Ablation Catheter, Sensor Enabled(TM) (TactiFlex SE) for treating drug-refractory, symptomatic paroxysmal atrial fibrillation. This clinical investigation will be conducted under an investigational device exemption and is intended to support market approval of the TactiFlex SE catheter worldwide. Three hundred and Fifty Five (355) subjects will be enrolled at up to 50 investigational sites worldwide. This clinical investigation is sponsored by Abbott.
Interventions
DEVICETactiFlex SE
Radiofrequency ablation with the TactiFlex SE ablation catheter. The procedure should be performed according to the TactiFlex SE investigational Instructions for Use document using the recommended ablation parameters as noted in the document.
DEVICETactiFlex SE - High Standard Power
Radiofrequency ablation with the TactiFlex SE ablation catheter. Subjects in the High Standard Power Substudy are to undergo the same study procedures as subjects in the main study, except that ablation power settings of 40-50 Watts are to be used in the left atrium, unless there is a medical reason to use a lower power.
Sponsors
Abbott Medical Devices
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
This is a prospective non-randomized parallel-assignment multi-center clinical investigation. The study design includes two subject cohorts: 1) Paroxysmal Atrial Fibrillation Main Study, and 2) Paroxysmal Atrial Fibrillation High Standard Power Substudy. Subjects in the main study cohorts are to be treated using the full range of ablation power settings in the Instructions For Use. Subjects in the Substudy are to be treated in the upper end of the recommended ablation power settings (40-50 Watts).
Eligibility
Sex/Gender
ALL
Age
18 Years to 99 Years
Healthy volunteers
No
Inclusion criteria
A patient will be eligible for clinical trial participation if he/she meets the following criteria: 1. Plans to undergo a catheter ablation procedure due to symptomatic paroxysmal atrial fibrillation 2. Physician's note indicating recurrent self-terminating atrial fibrillation 3. One electrocardiographically documented atrial fibrillation episode within 12-months prior to informed consent/enrollment. Documented evidence of the atrial fibrillation episode must either be continuous atrial fibrillation on a 12-lead ECG or include at least 30 seconds of atrial fibrillation from another ECG device. 4. At least 18 years of age 5. Able and willing to comply with all trial requirements 6. Informed of the nature of the trial, agreed to its provisions and has provided written informed consent as approved by the Institutional Review Board/Ethics Committee of the respective clinical trial site. A patient will be excluded from enrollment in the clinical trial if he/she meets any of the following criteria: 1. Persistent or long-standing persistent atrial fibrillation 2. Active systemic infection 3. Known presence of cardiac thrombus 4. Hypertrophic cardiomyopathy 5. Arrhythmia due to reversible causes including thyroid disorders, acute alcohol intoxication, and other major surgical procedures in the 90-day period preceding procedure 6. Myocardial infarction, acute coronary syndrome, percutaneous coronary intervention, or valve or coronary bypass grafting surgery within 90 days of procedure 7. Left atrial diameter \> 5.0 cm measured within 180 days of procedure (echocardiography or computerized tomography) 8. Left ventricular ejection fraction \< 35% measured within 180 days of procedure (echocardiography or computerized tomography) 9. New York Heart Association class III or IV 10. Previous left atrial surgical or catheter ablation procedure 11. Left atrial surgical procedure or incision with resulting scar (including left atrial appendage closure device) 12. Previous tricuspid or mitral valve replacement or repair 13. Heart disease in which corrective surgery is anticipated within 180 days after the procedure 14. Bleeding diathesis or suspected pro-coagulant state 15. Contraindication to long term anti-thromboembolic therapy 16. Presence of any condition that precludes appropriate vascular access 17. Renal failure requiring dialysis 18. Known sensitivity to contrast media (if needed during the procedure) that cannot be controlled with pre-medication 19. Severe pulmonary disease (e.g., restrictive pulmonary disease, constrictive or chronic obstructive pulmonary disease) or any other disease or malfunction of the lungs or respiratory system that produces severe chronic symptoms 20. Women who are pregnant or breastfeeding 21. Presence of other anatomic or comorbid condition that, in the investigator's opinion, could limit the patient's ability to participate in the clinical trial or to comply with follow up requirements, or impact the scientific soundness of the clinical trial results 22. Patient is currently participating in another clinical trial or has participated in a clinical trial within 30 days prior to screening that may interfere with this clinical trial 23. Patient is unlikely to survive the protocol follow up period of 12-months after the procedure 24. Body mass index \> 40 kg/m2 25. Presence of other medical, social, or psychological conditions that, in the investigator's opinion, could limit the subject's ability to participate in the clinical investigation or to comply with follow-up requirements, or impact the scientific soundness of the clinical investigation results. 26. Individuals without legal authority 27. Individuals unable to read or write 28. Patients who have had a ventriculotomy or atriotomy within the preceding 4 weeks of procedure, 29. Patients with prosthetic valves, 30. Patients with a myxoma, 31. Patients with an interatrial baffle or patch as the transseptal puncture could persist and produce an iatrogenic atrial shunt 32. Patient unable to receive heparin or an acceptable alternative to achieve adequate anticoagulation 33. Stroke or transient ischemic attack within the last 90 days 34. Stent, constriction, or stenosis in a pulmonary vein. 35. Rheumatic heart disease 36. Severe mitral regurgitation (regurgitant volume ≥ 60 mL/beat, regurgitant fraction ≥ 50%, and/or effective regurgitant orifice area ≥ 0.40cm2).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Device or Procedure-related Serious Adverse Events | Through 12 months | Tthe rate of device and/or procedure-related serious adverse events with onset within 7-days of any ablation procedure that uses the TactiFlex SE catheter (initial or repeat procedure performed 31-80 days of initial procedure) that are defined below: * Atrio-esophageal fistula1 * Cardiac tamponade/perforation1 * Death * Heart block * Myocardial infarction * Pericarditis * Phrenic nerve injury resulting in diaphragmatic paralysis * Pulmonary edema * Pulmonary vein stenosis1 * Stroke/cerebrovascular accident * Thromboembolism * Transient ischemic attack * Vagal nerve injury/gastroparesis * Vascular access complications (including major bleeding events) 1. Atrio-esophageal fistula, cardiac tamponade/perforation and pulmonary vein stenosis will be evaluated through 12-months. |
| KM Rate of Freedom From Atrial Fibrillation, Atrial Flutter or Atrial Tachycardia Recurrence | Through 12 months | Freedom from documented (symptomatic or asymptomatic) Atrial Fibrillation/Atrial Flutter/Atrial Tachycardia episodes of \>30 seconds duration that are documented by 12-lead ECG, transtelephonic monitoring or Holter monitor after the initial catheter ablation procedure through 12-months of follow-up. Recurrence during the 90-day blanking period will not be considered a treatment failure. One repeat procedure will be allowed during the blanking period. Failure to achieve acute procedural success during the last ablation procedure with the TactiFlex SE catheter will constitute failure. After the 90-day blanking period, use of Class I or III anti-arrhythmic drugs will not count as a therapy failure provided that only previously failed drugs are taken at doses that do not exceed the previously failed dose. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| KM Rate of Freedom From Symptomatic Atrial Fibrillation, Atrial Flutter or Atrial Tachycardia Recurrence | Through 12 months | Freedom from documented symptomatic atrial fibrillation/atrial flutter/atrial tachycardia episodes of \>30 seconds duration that are documented by 12-lead ECG, transtelephonic monitoring or Holter monitor after the initial catheter ablation procedure through 12-months of follow-up. Recurrence during the 90-day blanking period (≤90 days post-initial procedure) will not be considered a treatment failure. One repeat procedure will be allowed for ablation 31-80 days after the initial procedure and will not be considered a treatment failure. Failure to achieve acute procedural success during the last ablation procedure with the TactiFlex SE catheter will constitute failure. After the 90-day blanking period, use of Class I or III anti-arrhythmias drugs will not count as a therapy failure provided that only previously failed Class I or III anti-arrhythmias drugs are taken at doses that do not exceed the previously failed dose. |
| KM Rate of Freedom From Atrial Fibrillation, Atrial Flutter or Atrial Tachycardia Recurrence With Only 1 Ablation Procedure | 12 months | Freedom from documented (symptomatic or asymptomatic) Atrial Fibrillation/Atrial Flutter/Atrial Tachycardia episodes of \>30 seconds duration that are documented by 12-lead ECG, transtelephonic monitoring or Holter monitor after the initial catheter ablation procedure through 12-months of follow-up. Recurrence during the 90-day blanking period (≤90 days post-initial procedure) will not be considered a treatment failure. Any repeat ablation procedure in the left atrium will be considered a treatment failure. Failure to achieve acute procedural success during the ablation procedure with the TactiFlex SE catheter will constitute failure. After the 90-day blanking period, use of Class I or III anti-arrhythmic drugs will not count as a therapy failure provided that only previously failed Class I or III anti-arrhythmic drugs are taken at doses that do not exceed the previously failed dose. |
| KM Rate of Freedom From Atrial Fibrillation, Atrial Flutter or Atrial Tachycardia Recurrence, Without Anti-arrhythmic Drugs | Through 12 months | Freedom from documented (symptomatic or asymptomatic) Atrial Fibrillation/Atrial Flutter/Atrial Tachycardia episodes of \>30 seconds duration that are documented by 12-lead ECG, transtelephonic monitoring or Holter monitor after the initial catheter ablation procedure through 12-months of follow-up (9 months after a 90-day blanking period). Recurrence during the 90-day blanking period (≤90 days post-initial procedure) will not be considered a treatment failure. One repeat procedure will be allowed for ablation 31-80 days after the initial procedure and will not be considered a treatment failure. Failure to achieve acute procedural success during the last ablation procedure with the TactiFlex SE catheter will constitute failure. After the 90-day blanking period, any use of a Class I or III anti-arrhythmic drugs will count as an effectiveness failure. |
Countries
Australia, Austria, Canada, Czechia, Germany, Hong Kong, Italy, Netherlands, Taiwan, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Paroxysmal AF - Main Study TactiFlex SE: Radiofrequency ablation with the TactiFlex SE ablation catheter. The procedure should be performed according to the TactiFlex SE investigational Instructions for Use document using the recommended ablation parameters as noted in the document. | 284 |
| Paroxysmal AF HSP Sub-Study TactiFlex SE - HSP: Radiofrequency ablation with the TactiFlex SE ablation catheter. Subjects in the HSP Substudy are to undergo the same study procedures as subjects in the main study, except that ablation power settings of 40-50 Watts are to be used in the left atrium, unless there is a medical reason to use a lower power. | 50 |
| Total | 334 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 2 | 0 |
| Overall Study | Did not meet Inclusion/Exclusion criteria | 7 | 0 |
| Overall Study | Enrollment Pause | 10 | 0 |
| Overall Study | Lost to Follow-up | 1 | 0 |
| Overall Study | Physician Decision | 0 | 1 |
| Overall Study | PI left institution | 3 | 0 |
| Overall Study | Procedure aborted prior to device insertion into the vasculature | 1 | 0 |
| Overall Study | Withdrawal by Subject | 13 | 1 |
Baseline characteristics
| Characteristic | Paroxysmal AF - Main Study | Paroxysmal AF HSP Sub-Study | Total |
|---|---|---|---|
| Age, Continuous | 65.0 years | 67.0 years | 65.0 years |
| Body Mass Index | 28.4 kg/m^2 | 28.35 kg/m^2 | 28.4 kg/m^2 |
| CHA2DS2Vasc Score | 2 units on a scale | 2 units on a scale | 2 units on a scale |
| Ethnicity (NIH/OMB) Hispanic or Latino | 5 Participants | 2 Participants | 7 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 264 Participants | 45 Participants | 309 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 15 Participants | 3 Participants | 18 Participants |
| Left Atrial Diameter | 40.0 Millimeters | 40.0 Millimeters | 40.0 Millimeters |
| Left Ventricular Ejection Fraction | 60.0 Percentage | 55.0 Percentage | 60.0 Percentage |
| New York Heart Association Functional Classification Class I | 54 Participants | 1 Participants | 55 Participants |
| New York Heart Association Functional Classification Class II | 27 Participants | 5 Participants | 32 Participants |
| New York Heart Association Functional Classification Class III or IV | 0 Participants | 0 Participants | 0 Participants |
| New York Heart Association Functional Classification No Heart Failure | 203 Participants | 44 Participants | 247 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 10 Participants | 2 Participants | 12 Participants |
| Race (NIH/OMB) Black or African American | 3 Participants | 1 Participants | 4 Participants |
| Race (NIH/OMB) More than one race | 1 Participants | 1 Participants | 2 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 8 Participants | 2 Participants | 10 Participants |
| Race (NIH/OMB) White | 262 Participants | 44 Participants | 306 Participants |
| Region of Enrollment Australia | 31 participants | 0 participants | 31 participants |
| Region of Enrollment Austria | 29 participants | 0 participants | 29 participants |
| Region of Enrollment Canada | 3 participants | 0 participants | 3 participants |
| Region of Enrollment Czechia | 7 participants | 0 participants | 7 participants |
| Region of Enrollment Germany | 22 participants | 0 participants | 22 participants |
| Region of Enrollment Hong Kong | 3 participants | 0 participants | 3 participants |
| Region of Enrollment Italy | 2 participants | 0 participants | 2 participants |
| Region of Enrollment Taiwan | 2 participants | 0 participants | 2 participants |
| Region of Enrollment United States | 185 participants | 50 participants | 235 participants |
| Sex: Female, Male Female | 104 Participants | 16 Participants | 120 Participants |
| Sex: Female, Male Male | 180 Participants | 34 Participants | 214 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 2 / 284 | 0 / 50 |
| other Total, other adverse events | 5 / 284 | 3 / 50 |
| serious Total, serious adverse events | 65 / 284 | 8 / 50 |
Outcome results
Primary
KM Rate of Freedom From Atrial Fibrillation, Atrial Flutter or Atrial Tachycardia Recurrence
Freedom from documented (symptomatic or asymptomatic) Atrial Fibrillation/Atrial Flutter/Atrial Tachycardia episodes of \>30 seconds duration that are documented by 12-lead ECG, transtelephonic monitoring or Holter monitor after the initial catheter ablation procedure through 12-months of follow-up. Recurrence during the 90-day blanking period will not be considered a treatment failure. One repeat procedure will be allowed during the blanking period. Failure to achieve acute procedural success during the last ablation procedure with the TactiFlex SE catheter will constitute failure. After the 90-day blanking period, use of Class I or III anti-arrhythmic drugs will not count as a therapy failure provided that only previously failed drugs are taken at doses that do not exceed the previously failed dose.
Time frame: Through 12 months
Population: All treated subjects
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Main Study | KM Rate of Freedom From Atrial Fibrillation, Atrial Flutter or Atrial Tachycardia Recurrence | 72.9 percentage |
| High Standard Power Sub-Study | KM Rate of Freedom From Atrial Fibrillation, Atrial Flutter or Atrial Tachycardia Recurrence | 71.8 percentage |
Primary
Number of Participants With Device or Procedure-related Serious Adverse Events
Tthe rate of device and/or procedure-related serious adverse events with onset within 7-days of any ablation procedure that uses the TactiFlex SE catheter (initial or repeat procedure performed 31-80 days of initial procedure) that are defined below: * Atrio-esophageal fistula1 * Cardiac tamponade/perforation1 * Death * Heart block * Myocardial infarction * Pericarditis * Phrenic nerve injury resulting in diaphragmatic paralysis * Pulmonary edema * Pulmonary vein stenosis1 * Stroke/cerebrovascular accident * Thromboembolism * Transient ischemic attack * Vagal nerve injury/gastroparesis * Vascular access complications (including major bleeding events) 1. Atrio-esophageal fistula, cardiac tamponade/perforation and pulmonary vein stenosis will be evaluated through 12-months.
Time frame: Through 12 months
Population: The primary safety analysis population for the primary safety endpoint included all treated subjects who have completed their 7-day follow-up visit; or crossed the end of the 7-day visit window without the visit but with a primary safety endpoint event.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Main Study | Number of Participants With Device or Procedure-related Serious Adverse Events | 12 Participants |
| High Standard Power Sub-Study | Number of Participants With Device or Procedure-related Serious Adverse Events | 2 Participants |
Secondary
KM Rate of Freedom From Atrial Fibrillation, Atrial Flutter or Atrial Tachycardia Recurrence With Only 1 Ablation Procedure
Freedom from documented (symptomatic or asymptomatic) Atrial Fibrillation/Atrial Flutter/Atrial Tachycardia episodes of \>30 seconds duration that are documented by 12-lead ECG, transtelephonic monitoring or Holter monitor after the initial catheter ablation procedure through 12-months of follow-up. Recurrence during the 90-day blanking period (≤90 days post-initial procedure) will not be considered a treatment failure. Any repeat ablation procedure in the left atrium will be considered a treatment failure. Failure to achieve acute procedural success during the ablation procedure with the TactiFlex SE catheter will constitute failure. After the 90-day blanking period, use of Class I or III anti-arrhythmic drugs will not count as a therapy failure provided that only previously failed Class I or III anti-arrhythmic drugs are taken at doses that do not exceed the previously failed dose.
Time frame: 12 months
Population: All treated subjects
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Main Study | KM Rate of Freedom From Atrial Fibrillation, Atrial Flutter or Atrial Tachycardia Recurrence With Only 1 Ablation Procedure | 71.5 percentage |
| High Standard Power Sub-Study | KM Rate of Freedom From Atrial Fibrillation, Atrial Flutter or Atrial Tachycardia Recurrence With Only 1 Ablation Procedure | 71.8 percentage |
Secondary
KM Rate of Freedom From Atrial Fibrillation, Atrial Flutter or Atrial Tachycardia Recurrence, Without Anti-arrhythmic Drugs
Freedom from documented (symptomatic or asymptomatic) Atrial Fibrillation/Atrial Flutter/Atrial Tachycardia episodes of \>30 seconds duration that are documented by 12-lead ECG, transtelephonic monitoring or Holter monitor after the initial catheter ablation procedure through 12-months of follow-up (9 months after a 90-day blanking period). Recurrence during the 90-day blanking period (≤90 days post-initial procedure) will not be considered a treatment failure. One repeat procedure will be allowed for ablation 31-80 days after the initial procedure and will not be considered a treatment failure. Failure to achieve acute procedural success during the last ablation procedure with the TactiFlex SE catheter will constitute failure. After the 90-day blanking period, any use of a Class I or III anti-arrhythmic drugs will count as an effectiveness failure.
Time frame: Through 12 months
Population: All treated subjects
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Main Study | KM Rate of Freedom From Atrial Fibrillation, Atrial Flutter or Atrial Tachycardia Recurrence, Without Anti-arrhythmic Drugs | 64.0 percentage |
| High Standard Power Sub-Study | KM Rate of Freedom From Atrial Fibrillation, Atrial Flutter or Atrial Tachycardia Recurrence, Without Anti-arrhythmic Drugs | 65.8 percentage |
Secondary
KM Rate of Freedom From Symptomatic Atrial Fibrillation, Atrial Flutter or Atrial Tachycardia Recurrence
Freedom from documented symptomatic atrial fibrillation/atrial flutter/atrial tachycardia episodes of \>30 seconds duration that are documented by 12-lead ECG, transtelephonic monitoring or Holter monitor after the initial catheter ablation procedure through 12-months of follow-up. Recurrence during the 90-day blanking period (≤90 days post-initial procedure) will not be considered a treatment failure. One repeat procedure will be allowed for ablation 31-80 days after the initial procedure and will not be considered a treatment failure. Failure to achieve acute procedural success during the last ablation procedure with the TactiFlex SE catheter will constitute failure. After the 90-day blanking period, use of Class I or III anti-arrhythmias drugs will not count as a therapy failure provided that only previously failed Class I or III anti-arrhythmias drugs are taken at doses that do not exceed the previously failed dose.
Time frame: Through 12 months
Population: All Treated Subjects
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Main Study | KM Rate of Freedom From Symptomatic Atrial Fibrillation, Atrial Flutter or Atrial Tachycardia Recurrence | 80.4 percentage |
| High Standard Power Sub-Study | KM Rate of Freedom From Symptomatic Atrial Fibrillation, Atrial Flutter or Atrial Tachycardia Recurrence | 75.9 percentage |