Refractory Paroxysmal Atrial Fibrillation
Conditions
Brief summary
The purpose of this study is to evaluate the long term off-Antiarrhythmic Drug (AAD) effectiveness of Biosense Webster, Inc. Irreversible Electroporation (BWI IRE) system in treatment of participants with symptomatic drug refractory paroxysmal atrial fibrillation (PAF).
Interventions
The multi-channel IRE Generator is intended for use during cardiac Pulsed Field Ablation (PFA) therapy. This device is used in conjunction with a compatible ablation catheter to create a closed electrical circuit capable of delivering pulsed electrical field energy.
The multi-channel circular IRE Catheter is indicated for use in catheter-based cardiac electrophysiological mapping (stimulating and recording) and when used with an IRE Generator, for cardiac ablation.
Sponsors
Study design
Eligibility
Inclusion criteria
* Diagnosed with symptomatic paroxysmal atrial fibrillation (PAF) (Physician's note indicating recurrent self-terminating atrial fibrillation \[AF\]). At least one electrocardiographically documented AF episode within twelve (12) months prior to enrollment. Electrocardiographic documentation may include, but is not limited to, electrocardiogram (ECG), Holter monitor, or telemetry strip * Failed at least one Class I or Class III antiarrhythmic drug (AAD) as evidenced by recurrent symptomatic AF, contraindicated or intolerable to both Class I and Class III AAD * Able and willing to comply with all pre-procedure, post-procedure, and follow-up testing and visit requirements * Willing and capable of providing consent
Exclusion criteria
* AF secondary to electrolyte imbalance, thyroid disease, or reversible or non-cardiac cause (Example, untreated documented obstructive sleep apnea and acute alcohol toxicity) * Previous left atrium (LA) ablation or surgery * Participants known to require ablation outside the pulmonary vein (PV) region (atrioventricular reentrant tachycardia, atrioventricular nodal reentry tachycardia, atrial tachycardia, atrial flutter of unknown origin, ventricular tachycardia and Wolff-Parkinson-White) * Previously diagnosed with persistent AF (greater than \[\>\] 7 days in duration) * Severe dilatation of the LA (documented LAD \>50 millimeters \[mm\] antero-posterior diameter by transthoracic echocardiography (TTE) within 6 month prior to enrollment)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Long-term Effectiveness | From Day 91 up to Day 365 post-procedure on Day 0 | Long-term effectiveness was defined as freedom from documented asymptomatic and symptomatic atrial fibrillation (AF), atrial tachycardia (AT), or atrial flutter (AFL; of unknown origin) episodes based on electrocardiographic data (greater than equal to \[\>=\] 30 seconds on arrhythmia monitoring device) through the effectiveness evaluation period (Day 91 through Day 365 post index procedure) and freedom from the following failure modes : freedom from acute procedural failure, freedom from non-study catheter failure, freedom from repeat ablation failure, freedom from direct Current (DC) cardioversion failure, freedom from recurrence (captured on 12-lead electrocardiogram \[ECG\]) failure, and freedom from anti-arrhythmic drug failure. AFL of unknown origin was defined as all AFL except those Cavo-Tricuspid Isthmus (CTI) dependent AFL as confirmed by accepted electrophysiology (EP) maneuvers (for example, entrainment or activation mapping) in an EP study. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Experiencing Serious Adverse Event (SAE) Within 7 Days, 8-30 Days and >30 Days of Initial Ablation Procedure | From day of procedure (Day 0) up to 12 months | Percentage of participants with SAEs within 7 days (early-onset), 8-30 days (peri-procedural) and \>30 days (late onset) of initial ablation procedure were reported. A SAE was any adverse event (AE) that resulted in a death or a serious deterioration in the health of the participant during the clinical trial, including a life-threatening illness or injury, a permanent impairment of a body structure or a body function, in-patient hospitalization or prolongation of existing hospitalization, medical or surgical intervention to prevent permanent impairment of a body structure or a body function; or resulted in fetal distress, foetal death or congenital abnormality, congenital anomaly, etc. |
| Percentage of Participants With Acute Procedural Success | On the day of procedure (Day 0) | Percentage of participants with acute procedural success were reported. Acute procedural success was defined as confirmation of entrance block in all clinically relevant targeted pulmonary veins (PVs) after adenosine/ isoproterenol challenge. Touching up with focal catheter was considered as acute procedural failure. |
| Percentage of Participants With Acute Reconnection | On the day of procedure (Day 0) | Percentage of participants with acute reconnection were reported. Acute reconnection was identified by adenosine/isoproterenol challenge among all clinically relevant targeted PVs and by participant. |
| Percentage of Participants Experiencing Primary Adverse Event (PAE) | Within 7 days post-procedure on Day 0 | Percentage of participants experiencing PAE were reported. An AE is any untoward medical occurrence in a participant whether or not related to the investigational medical device. Primary AEs within seven days of the ablation procedure which used investigational devices per protocol, including the initial and repeat procedures were reported. PAEs included cardiac tamponade, perforation, myocardial infarction, stroke/cerebrovascular accident, thromboembolism, transient ischaemic attack, phrenic nerve injury/diaphragmatic paralysis, heart block, pulmonary vein stenosis, pulmonary oedema (respiratory insufficiency), vagal nerve injury/gastroparesis, pericarditis, major vascular access complication/bleeding, and atrio-esophageal fistula . |
| Percentage of Participants With Pulmonary Vein (PV) Ablation | On day of procedure (Day 0) | Percentage of participants with PV ablation by a non-study catheter (touch-up) among all clinically relevant targeted participants were reported. |
| Percentage of Participants With Repeated Ablation | From the day of procedure (Day 0) up to 12 months | Percentage of participants with repeated ablation within the 12 months follow up period, including timing (blanking period or after blanking) were reported. Repeat procedures for AF/AT/AFL of unknown origin plus recurrences during the blanking period (90 days post index procedure) were conducted with the investigational device for ablating PV reconnections. Repeat procedures performed after the blanking period were managed per investigator discretion using a commercially available ablation catheter and generator. |
| Percentage of Pulmonary Veins (PVs) With Acute Reconnection | On the day of procedure (Day 0) | Percentage of PVs with acute reconnection were reported. Acute reconnection was identified by adenosine/isoproterenol challenge among all clinically relevant targeted PVs and by participant. |
Countries
China
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Irreversible Electroporation (IRE) System Participants with symptomatic drug refractory paroxysmal atrial fibrillation (PAF) and indicated for catheter ablation were treated with the IRE system which included multi-electrode circular IRE catheter and the multi-channel IRE generator. | 142 |
| Total | 142 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Lost to Follow-up | 1 |
| Overall Study | Study catheter was inserted, but PF energy was not delivered due to ECG interference | 1 |
Baseline characteristics
| Characteristic | Irreversible Electroporation (IRE) System | — |
|---|---|---|
| Age, Continuous | 56.9 Years STANDARD_DEVIATION 12.04 | — |
| Age, Customized <45 years | 26 Participants | — |
| Age, Customized >=65 years | 49 Participants | — |
| Age, Customized Between 45 to <65 years | 67 Participants | — |
| Race and Ethnicity Not Collected | — | — Participants |
| Sex: Female, Male Female | 61 Participants | — |
| Sex: Female, Male Male | 81 Participants | — |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 142 |
| other Total, other adverse events | 13 / 142 |
| serious Total, serious adverse events | 16 / 142 |
Outcome results
Percentage of Participants With Long-term Effectiveness
Long-term effectiveness was defined as freedom from documented asymptomatic and symptomatic atrial fibrillation (AF), atrial tachycardia (AT), or atrial flutter (AFL; of unknown origin) episodes based on electrocardiographic data (greater than equal to \[\>=\] 30 seconds on arrhythmia monitoring device) through the effectiveness evaluation period (Day 91 through Day 365 post index procedure) and freedom from the following failure modes : freedom from acute procedural failure, freedom from non-study catheter failure, freedom from repeat ablation failure, freedom from direct Current (DC) cardioversion failure, freedom from recurrence (captured on 12-lead electrocardiogram \[ECG\]) failure, and freedom from anti-arrhythmic drug failure. AFL of unknown origin was defined as all AFL except those Cavo-Tricuspid Isthmus (CTI) dependent AFL as confirmed by accepted electrophysiology (EP) maneuvers (for example, entrainment or activation mapping) in an EP study.
Time frame: From Day 91 up to Day 365 post-procedure on Day 0
Population: Full analysis set (FAS) included all enrolled non-roll-in participants who were ablated with investigational devices. Here, 'N' (overall number of participants analyzed) signifies participants evaluable for this outcome measure.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Irreversible Electroporation (IRE) System | Percentage of Participants With Long-term Effectiveness | 74.6 Percentage of participants |
Percentage of Participants Experiencing Primary Adverse Event (PAE)
Percentage of participants experiencing PAE were reported. An AE is any untoward medical occurrence in a participant whether or not related to the investigational medical device. Primary AEs within seven days of the ablation procedure which used investigational devices per protocol, including the initial and repeat procedures were reported. PAEs included cardiac tamponade, perforation, myocardial infarction, stroke/cerebrovascular accident, thromboembolism, transient ischaemic attack, phrenic nerve injury/diaphragmatic paralysis, heart block, pulmonary vein stenosis, pulmonary oedema (respiratory insufficiency), vagal nerve injury/gastroparesis, pericarditis, major vascular access complication/bleeding, and atrio-esophageal fistula .
Time frame: Within 7 days post-procedure on Day 0
Population: Safety analysis set included all the enrolled participants (including both non roll-in and roll-in participants) who had the investigational devices inserted or treated.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Irreversible Electroporation (IRE) System | Percentage of Participants Experiencing Primary Adverse Event (PAE) | 2.1 Percentage of participants |
Percentage of Participants Experiencing Serious Adverse Event (SAE) Within 7 Days, 8-30 Days and >30 Days of Initial Ablation Procedure
Percentage of participants with SAEs within 7 days (early-onset), 8-30 days (peri-procedural) and \>30 days (late onset) of initial ablation procedure were reported. A SAE was any adverse event (AE) that resulted in a death or a serious deterioration in the health of the participant during the clinical trial, including a life-threatening illness or injury, a permanent impairment of a body structure or a body function, in-patient hospitalization or prolongation of existing hospitalization, medical or surgical intervention to prevent permanent impairment of a body structure or a body function; or resulted in fetal distress, foetal death or congenital abnormality, congenital anomaly, etc.
Time frame: From day of procedure (Day 0) up to 12 months
Population: Safety analysis set included all the enrolled participants (including both non roll-in and roll-in participants) who had the investigational devices inserted or treated.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Irreversible Electroporation (IRE) System | Percentage of Participants Experiencing Serious Adverse Event (SAE) Within 7 Days, 8-30 Days and >30 Days of Initial Ablation Procedure | Within 7 days (early-onset) of index ablation procedure | 2.8 Percentage of participants |
| Irreversible Electroporation (IRE) System | Percentage of Participants Experiencing Serious Adverse Event (SAE) Within 7 Days, 8-30 Days and >30 Days of Initial Ablation Procedure | Within 8-30 days (peri-procedural) | 0.7 Percentage of participants |
| Irreversible Electroporation (IRE) System | Percentage of Participants Experiencing Serious Adverse Event (SAE) Within 7 Days, 8-30 Days and >30 Days of Initial Ablation Procedure | >30 days (late onset) | 6.3 Percentage of participants |
Percentage of Participants With Acute Procedural Success
Percentage of participants with acute procedural success were reported. Acute procedural success was defined as confirmation of entrance block in all clinically relevant targeted pulmonary veins (PVs) after adenosine/ isoproterenol challenge. Touching up with focal catheter was considered as acute procedural failure.
Time frame: On the day of procedure (Day 0)
Population: Full analysis set (FAS) included all enrolled non-roll-in participants who were ablated with investigational devices.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Irreversible Electroporation (IRE) System | Percentage of Participants With Acute Procedural Success | 100 Percentage of participants |
Percentage of Participants With Acute Reconnection
Percentage of participants with acute reconnection were reported. Acute reconnection was identified by adenosine/isoproterenol challenge among all clinically relevant targeted PVs and by participant.
Time frame: On the day of procedure (Day 0)
Population: Full analysis set (FAS) included all enrolled non-roll-in participants who were ablated with investigational devices.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Irreversible Electroporation (IRE) System | Percentage of Participants With Acute Reconnection | 10.6 Percentage of participants |
Percentage of Participants With Pulmonary Vein (PV) Ablation
Percentage of participants with PV ablation by a non-study catheter (touch-up) among all clinically relevant targeted participants were reported.
Time frame: On day of procedure (Day 0)
Population: Full analysis set (FAS) included all enrolled non-roll-in participants who were ablated with investigational devices.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Irreversible Electroporation (IRE) System | Percentage of Participants With Pulmonary Vein (PV) Ablation | 0 Percentage of participants |
Percentage of Participants With Repeated Ablation
Percentage of participants with repeated ablation within the 12 months follow up period, including timing (blanking period or after blanking) were reported. Repeat procedures for AF/AT/AFL of unknown origin plus recurrences during the blanking period (90 days post index procedure) were conducted with the investigational device for ablating PV reconnections. Repeat procedures performed after the blanking period were managed per investigator discretion using a commercially available ablation catheter and generator.
Time frame: From the day of procedure (Day 0) up to 12 months
Population: Full analysis set (FAS) included all enrolled non-roll-in participants who were ablated with investigational devices.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Irreversible Electroporation (IRE) System | Percentage of Participants With Repeated Ablation | 6.5 Percentage of participants |
Percentage of Pulmonary Veins (PVs) With Acute Reconnection
Percentage of PVs with acute reconnection were reported. Acute reconnection was identified by adenosine/isoproterenol challenge among all clinically relevant targeted PVs and by participant.
Time frame: On the day of procedure (Day 0)
Population: Full analysis set (FAS) included all enrolled non-roll-in participants who were ablated with investigational devices.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Irreversible Electroporation (IRE) System | Percentage of Pulmonary Veins (PVs) With Acute Reconnection | 4.7 Percentage of pulmonary veins |