Atrial Fibrillation
Conditions
Brief summary
The purpose of this study is to demonstrate safety and effectiveness of the ablation system (THERMOCOOL SMARTTOUCH SF \[STSF\] catheter and TRUPULSE generator) when used for isolation of the atrial pulmonary veins (PVs) in treatment of participants with paroxysmal atrial fibrillation (PAF).
Interventions
Participants will undergo catheter ablation with the PF /RF ablation system consisting of the TRUPULSE Generator (delivers RF or PF energy through the study catheter) and the THERMOCOOL SMARTTOUCH SF (STSF) Catheter (indicated for use in catheter-based cardiac electrophysiological mapping (stimulating and recording) and, when used with a Generator, for cardiac ablation).
Sponsors
Study design
Eligibility
Inclusion criteria
* Diagnosed with symptomatic paroxysmal atrial fibrillation (PAF) defined as atrial fibrillation (AF) that terminates spontaneously or with intervention within 7 days of onset. This PAF is considered to be symptomatic if symptoms related to AF are experienced by the participant * Selected for AF ablation procedure by pulmonary vein isolation (PVI) * Failed at least one antiarrhythmic drug (AAD) (class I to IV) as evidenced by recurrent symptomatic AF, or intolerable or contraindicated to the AAD * Willing and capable of providing consent * Able and willing to comply with all pre-, post- and follow-up testing and requirements.
Exclusion criteria
* Previously known AF secondary to electrolyte imbalance, thyroid disease, or reversible or non-cardiac cause (example, documented obstructive sleep apnea, acute alcohol toxicity, morbid obesity {Body Mass Index greater than \[\>\] 40 kilograms per meter square \[kg/m²\]}, renal insufficiency (with an estimated creatinine clearance less than \[\<\] 30 milliliters \[mL\]/ minute \[min\]/1.73 meter square \[m2\] ) * Previous left atrium (LA) ablation or surgery * Patients known to require ablation outside the pulmonary vein (PV) region (example, atrioventricular reentrant tachycardia, atrioventricular nodal reentry tachycardia, atrial tachycardia, ventricular tachycardia and wolff-parkinson-white) * Previously diagnosed with persistent AF \[greater than (\>) 7 days in duration\] * Severe dilatation of the left atrium (LA) (Left anterior descending artery \[LAD\] \>50mm antero-posterior diameter in case of Transthoracic Echocardiography \[TTE\])
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Primary Adverse Events (PAEs) | 90 days post-procedure on Day 1 | Percentage of participants with PAEs (within 7 days following the ablation procedure) was reported. PAEs included the following adverse events atrio-esophageal fistula, pulmonary vein stenosis, device or procedure related death, (that occurred greater than 7 days and less than or equal to 90 days post-procedure), phrenic nerve paralysis (permanent), cardiac tamponade/perforation, stroke/cerebrovascular accident (CVA), major vascular access complication/bleeding, thromboembolism, myocardial infarction, transient ischemic attack (TIA), pericarditis, heart block, pulmonary edema (respiratory insufficiency), and vagal nerve injury/gastroparesis. |
| Percentage of Participants With Acute Procedural Success | Immediately post-procedure on Day 1 | Percentage of participants with acute procedural success were reported. Procedural success was defined as electrical isolation of clinically relevant targeted pulmonary veins (PVs) (confirmed by entrance block) after adenosine/isoproterenol challenge at the end of the index ablation procedure. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Freedom From Documented (Symptomatic and Asymptomatic) Atrial Arrhythmia | Day 91 to Day 365 | Percentage of participants with freedom from documented (symptomatic and asymptomatic) atrial arrhythmia episodes including atrial fibrillation (AF), atrial tachycardia (AT), or atrial flutter (AFL; unknown origin) episodes based on electrocardiographic data (greater than equal to \[\>=\]30 seconds on arrhythmia monitoring device) were reported. Participants with an AF/AT/AFL (of unknown origin) episode that is \>=30 seconds on arrhythmia monitoring device during the evaluation period were considered failures of this long-term effectiveness outcome measure. Acute procedural failure (that is, failure to achieve entrance block with the study device in any of the targeted pulmonary vein \[PVs\]) were also deemed a failure of this outcome measure. AFL of unknown origin was defined as all AFL except those cavotricuspid isthmus (CTI) dependent AFL as confirmed by 12-lead electrocardiogram (ECG) or entrainment maneuvers in an electrophysiology (EP) study. |
Countries
Austria, Belgium, Denmark, Lithuania
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Pulsed Field (PF) /Radiofrequency (RF) Catheter Ablation Participants with drug refractory, paroxysmal atrial fibrillation (PAF) who were candidates for catheter ablation were enrolled and treated with THERMOCOOL SMARTTOUCH SF (STSF) catheter and TRUPULSE generator to deliver radiofrequency (RF) or pulse field (PF) energy during cardiac ablation procedures . | 140 |
| Total | 140 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Enrolled, not treated | 9 |
| Overall Study | Study catheter inserted but did not undergo ablation | 1 |
| Overall Study | Withdrawal by Subject | 2 |
Baseline characteristics
| Characteristic | Pulsed Field (PF) /Radiofrequency (RF) Catheter Ablation | — |
|---|---|---|
| Age, Continuous | 61.6 Years STANDARD_DEVIATION 7.79 | — |
| Race and Ethnicity Not Collected | — | — Participants |
| Sex: Female, Male Female | 60 Participants | — |
| Sex: Female, Male Male | 80 Participants | — |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 149 |
| other Total, other adverse events | 90 / 149 |
| serious Total, serious adverse events | 23 / 149 |
Outcome results
Percentage of Participants With Acute Procedural Success
Percentage of participants with acute procedural success were reported. Procedural success was defined as electrical isolation of clinically relevant targeted pulmonary veins (PVs) (confirmed by entrance block) after adenosine/isoproterenol challenge at the end of the index ablation procedure.
Time frame: Immediately post-procedure on Day 1
Population: The per protocol analysis set included enrolled eligible participants who had undergone ablation using PF and/or RF energy via the investigational ablation system per clinical investigational plan (CIP), were treated for the study-related arrythmia, and without major CIP deviation that effected the scientific integrity of the safety and effectiveness.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Pulsed Field (PF) /Radiofrequency (RF) Catheter Ablation | Percentage of Participants With Acute Procedural Success | 100 Percentage of participants |
Percentage of Participants With Primary Adverse Events (PAEs)
Percentage of participants with PAEs (within 7 days following the ablation procedure) was reported. PAEs included the following adverse events atrio-esophageal fistula, pulmonary vein stenosis, device or procedure related death, (that occurred greater than 7 days and less than or equal to 90 days post-procedure), phrenic nerve paralysis (permanent), cardiac tamponade/perforation, stroke/cerebrovascular accident (CVA), major vascular access complication/bleeding, thromboembolism, myocardial infarction, transient ischemic attack (TIA), pericarditis, heart block, pulmonary edema (respiratory insufficiency), and vagal nerve injury/gastroparesis.
Time frame: 90 days post-procedure on Day 1
Population: Modified intention-to-treat (mITT) analysis set included all enrolled participants who met eligibility criteria and had insertion of the study catheter. Here, 'N' (number of participants analyzed) refers to participants who were evaluable for this outcome measure.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Pulsed Field (PF) /Radiofrequency (RF) Catheter Ablation | Percentage of Participants With Primary Adverse Events (PAEs) | Atrio-esophageal Fistula | 0.0 percentage of participants |
| Pulsed Field (PF) /Radiofrequency (RF) Catheter Ablation | Percentage of Participants With Primary Adverse Events (PAEs) | Phrenic Nerve Paralysis (permanent) | 0.0 percentage of participants |
| Pulsed Field (PF) /Radiofrequency (RF) Catheter Ablation | Percentage of Participants With Primary Adverse Events (PAEs) | Stroke/Cerebrovascular Accident (CVA) | 0.7 percentage of participants |
| Pulsed Field (PF) /Radiofrequency (RF) Catheter Ablation | Percentage of Participants With Primary Adverse Events (PAEs) | Transient Ischemic Attack (TIA) | 0.0 percentage of participants |
| Pulsed Field (PF) /Radiofrequency (RF) Catheter Ablation | Percentage of Participants With Primary Adverse Events (PAEs) | Major Vascular Access Complication / Bleeding | 0.0 percentage of participants |
| Pulsed Field (PF) /Radiofrequency (RF) Catheter Ablation | Percentage of Participants With Primary Adverse Events (PAEs) | Thromboembolism | 0.0 percentage of participants |
| Pulsed Field (PF) /Radiofrequency (RF) Catheter Ablation | Percentage of Participants With Primary Adverse Events (PAEs) | Pulmonary Edema (Respiratory Insufficiency) | 0.0 percentage of participants |
| Pulsed Field (PF) /Radiofrequency (RF) Catheter Ablation | Percentage of Participants With Primary Adverse Events (PAEs) | Vagal Nerve injury/Gastroparesis | 0.0 percentage of participants |
| Pulsed Field (PF) /Radiofrequency (RF) Catheter Ablation | Percentage of Participants With Primary Adverse Events (PAEs) | Death (Device or procedure related) | 0.0 percentage of participants |
| Pulsed Field (PF) /Radiofrequency (RF) Catheter Ablation | Percentage of Participants With Primary Adverse Events (PAEs) | Pulmonary Vein Stenosis | 1.5 percentage of participants |
| Pulsed Field (PF) /Radiofrequency (RF) Catheter Ablation | Percentage of Participants With Primary Adverse Events (PAEs) | Cardiac Tamponade/perforation | 1.5 percentage of participants |
| Pulsed Field (PF) /Radiofrequency (RF) Catheter Ablation | Percentage of Participants With Primary Adverse Events (PAEs) | Myocardial Infarction | 0.0 percentage of participants |
| Pulsed Field (PF) /Radiofrequency (RF) Catheter Ablation | Percentage of Participants With Primary Adverse Events (PAEs) | Pericarditis | 0.7 percentage of participants |
| Pulsed Field (PF) /Radiofrequency (RF) Catheter Ablation | Percentage of Participants With Primary Adverse Events (PAEs) | Heart Block | 0.0 percentage of participants |
Percentage of Participants With Freedom From Documented (Symptomatic and Asymptomatic) Atrial Arrhythmia
Percentage of participants with freedom from documented (symptomatic and asymptomatic) atrial arrhythmia episodes including atrial fibrillation (AF), atrial tachycardia (AT), or atrial flutter (AFL; unknown origin) episodes based on electrocardiographic data (greater than equal to \[\>=\]30 seconds on arrhythmia monitoring device) were reported. Participants with an AF/AT/AFL (of unknown origin) episode that is \>=30 seconds on arrhythmia monitoring device during the evaluation period were considered failures of this long-term effectiveness outcome measure. Acute procedural failure (that is, failure to achieve entrance block with the study device in any of the targeted pulmonary vein \[PVs\]) were also deemed a failure of this outcome measure. AFL of unknown origin was defined as all AFL except those cavotricuspid isthmus (CTI) dependent AFL as confirmed by 12-lead electrocardiogram (ECG) or entrainment maneuvers in an electrophysiology (EP) study.
Time frame: Day 91 to Day 365
Population: The per protocol analysis set included enrolled eligible participants who had undergone ablation using PF and/or RF energy via the investigational ablation system per clinical investigational plan (CIP), were treated for the study-related arrythmia, and without major CIP deviation that effected the scientific integrity of the safety and effectiveness. Here, 'N' (overall number of participants analyzed) signifies number of participants evaluable for this outcome measure.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Pulsed Field (PF) /Radiofrequency (RF) Catheter Ablation | Percentage of Participants With Freedom From Documented (Symptomatic and Asymptomatic) Atrial Arrhythmia | 71.6 Percentage of participants |