- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01091389
Atrial Fibrillation Ablation and Autonomic Modulation Via Thorascopic Surgery (AFACT)
A Randomized Single Center Study to Prospectively Investigate the Effect of Ablation of the Autonomic Ganglia in Addition to Minimally Invasive Surgical Isolation of Pulmonary Veins in Patients With Atrial Fibrillation
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Atrial fibrillation (AF) is the most common chronic arrhythmia in man. Its treatment consists of control of ventricular rate or attempts to restore sinus rhythm. For symptomatic patients who fail on anti arrhythmic drugs, isolation of the pulmonary veins (PV), with additional linear left atrial lesions when appropriate, can cure AF. At least in some, but probably in many patients, the autonomous nervous system plays a pivotal role in the initiation and perpetuation of AF. The autonomic ganglia, or ganglionated plexi (GP) are located within the epicardial fat pads of the left atrium. This study aims at investigating the additional value of ablation of those GPs in addition to totally thoracoscopic PV isolation.
Objective of the study:
This study aims at investigating the role of autonomic modulation of AF. Therefore, totally thoracoscopic PV isolation with additional ablation of ganglionated plexi (GP) will be studied against PV isolation alone. Two groups of patients (paroxysmal AF with or without structural heart disease and persistent AF with or without heart disease) of 110 patients each will be studied.
Study design:
This is a single center, randomized single blinded study
Study population:
Any patient with an indication for non-pharmacological treatment of symptomatic paroxysmal or persistent AF can enter the study. An indication for non-pharmacological treatment exists when patients are symptomatic and have failed on at least one anti-arrhythmic drug. Symptoms of AF include, but are not limited to palpitations, reduced exercise capacity, exertional dyspnea, and fatigue. Failure of anti-arrhythmic therapy is defined as 1) recurrence of AF despite the use of an anti-arrhythmic drug in a clinical efficacious dosing or 2) adverse effects of medication that is not acceptable to the patient.
Intervention (if applicable):
In patients randomized to additional GP ablation, the following procedures will be carried out during the totally thoracoscopic procedure in addition to the PV isolation (and extended lesion set when appropriate): The left atrial autonomic GPs are localized within the epicardial fat pads and subsequently ablated with radiofrequency current delivered through an ablation probe (AtriCure Isolator™ Transpolar™ pen).
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
-
-
-
Amsterdam, Netherlands, 1100 DD
- Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age is between 18 and 80 years
- AF is symptomatic, paroxysmal or persistent (hence not long standing persistent)
- In case of persistent AF, successful cardioversion within the last 12 months (cardioversion will be considered failed if AF recurs within 48 hours)
- AF was documented on ECG, Holter or pacemaker electrogram at least once in the 6 months preceding presentation
- At least one class I or III antiarrhythmic drug in standard dosage has failed or is not tolerated
- Legally competent and willing and able to sign informed consent
- Willing and able to adhere to the follow up visit protocol
- Life expectancy of ≥2 years
Exclusion Criteria:
- Prior catheter ablation for AF within the preceding 4 months
- Refusal to take antiarrhythmic medication
- Myocardial infarction (defined as CKMB> twice upper limit of normal) within the preceding 2 months
- NYHA class IV/IV heart failure symptoms, or class II-III with a recent decompensation requiring hospitalization or left ventricular ejection fraction<35% (unless related to or aggravated by AF).
- Cerebrovascular accident (defined as any sudden neurological deficit lasting longer than 24 hours, with or without pathological changes on the CT cerebrum) with the preceding 6 months
- Known and documented carotid stenosis>80%
- Planned cardiac surgery for other purposes than AF (alone)
- Evidence of active infection (as evidenced by increased white blood cell count, elevated CRP level or fever >38,5 °C)
- Unable to undergo TEE
- Pregnancy or of childbearing potential without adequate contraception
- Requirement of antiarrhythmic medication for ventricular arrhythmias
- Presence of intracardiac mass or thrombus (Discovery of any thrombus or intracardiac mass after signing of the informed consent will result in withdrawal of the patient from the study)
- Co-morbid condition that possesses undue risk of general anesthesia or port access cardiac surgery (in the opinion of the investigator)
- History of previous radiation therapy on the thorax
- Circumstances that prevent follow-up (no permanent home or address, transient, etc.)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: SINGLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: GP ablation
Thoracoscopic PV isolation with GP ablation
|
Surgery is performed through three ports bilaterally in the intercostal spaces.
PVI is performed with a bipolar radiofrequency clamp and confirmed with a custom made multi-electrode probe with closely spaced (1mm) electrode terminals.
Additional left atrial ablation lines are created and conduction block is verified in patients with persistent and permanent AF.
Other Names:
|
EXPERIMENTAL: No GP ablation
Thoracoscopic PV isolation with no GP ablation
|
Surgery is performed through three ports bilaterally in the intercostal spaces.
PVI is performed with a bipolar radiofrequency clamp and confirmed with a custom made multi-electrode probe with closely spaced (1mm) electrode terminals.
Additional left atrial ablation lines are created and conduction block is verified in patients with persistent and permanent AF.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The primary endpoint of the study is freedom of AF after one year after the procedure without the use of antiarrhythmic drugs.
Time Frame: One year
|
The primary endpoint of the study is freedom of AF after one year after the procedure without the use of antiarrhythmic drugs.
Freedom of AF is defined as the absence of documentation of AF on serial Holter recordings during follow up and on ECGs recorded outside the scope of the study.
One single episode of <30 minutes is allowed.
Patients complaints about palpitations without the documentation of AF is allowed.
|
One year
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Freedom of AF after two years after the procedure without the use of any antiarrhythmic drug
Time Frame: Two Years
|
Freedom of AF after two years after the procedure without the use of any antiarrhythmic drug.
Definition of freedom of AF as above.
|
Two Years
|
Quality of life
Time Frame: One Year
|
Improvement of functional status as measured by the RAND 36 quality of life questionnaires
|
One Year
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: J.R. De Groot, MD, PhD, Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Publications and helpful links
General Publications
- Driessen AHG, Berger WR, Krul SPJ, van den Berg NWE, Neefs J, Piersma FR, Chan Pin Yin DRPP, de Jong JSSG, van Boven WP, de Groot JR. Ganglion Plexus Ablation in Advanced Atrial Fibrillation: The AFACT Study. J Am Coll Cardiol. 2016 Sep 13;68(11):1155-1165. doi: 10.1016/j.jacc.2016.06.036.
- Wesselink R, Neefs J, van den Berg NWE, Meulendijks ER, Terpstra MM, Kawasaki M, Nariswari FA, Piersma FR, van Boven WJP, Driessen AHG, de Groot JR. Does left atrial epicardial conduction time reflect atrial fibrosis and the risk of atrial fibrillation recurrence after thoracoscopic ablation? Post hoc analysis of the AFACT trial. BMJ Open. 2022 Mar 9;12(3):e056829. doi: 10.1136/bmjopen-2021-056829.
- Reyat JS, Chua W, Cardoso VR, Witten A, Kastner PM, Kabir SN, Sinner MF, Wesselink R, Holmes AP, Pavlovic D, Stoll M, Kaab S, Gkoutos GV, de Groot JR, Kirchhof P, Fabritz L. Reduced left atrial cardiomyocyte PITX2 and elevated circulating BMP10 predict atrial fibrillation after ablation. JCI Insight. 2020 Aug 20;5(16):e139179. doi: 10.1172/jci.insight.139179.
- Berger WR, Neefs J, van den Berg NWE, Krul SPJ, van Praag EM, Piersma FR, de Jong JSSG, van Boven WP, Driessen AHG, de Groot JR. Additional Ganglion Plexus Ablation During Thoracoscopic Surgical Ablation of Advanced Atrial Fibrillation: Intermediate Follow-Up of the AFACT Study. JACC Clin Electrophysiol. 2019 Mar;5(3):343-353. doi: 10.1016/j.jacep.2018.10.008. Epub 2018 Nov 28.
Study record dates
Study Major Dates
Study Start
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- NL30199.018.10
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Atrial Fibrillation
-
Ablacon, Inc.CompletedArrhythmias, Cardiac | Atrial Fibrillation, Persistent | Persistent Atrial Fibrillation | Longstanding Persistent Atrial FibrillationGermany
-
Ablacon, Inc.RecruitingAtrial Fibrillation | Arrhythmias, Cardiac | Arrhythmia | Atrial Flutter | Atrial Fibrillation, Persistent | Atrial Tachycardia | Atrial Arrhythmia | Atrial Fibrillation Paroxysmal | Atrial Fibrillation, Paroxysmal or PersistentUnited States, Belgium, Netherlands, Czechia
-
Barts & The London NHS TrustAtriCure, Inc.Not yet recruitingAtrial Fibrillation, Persistent | Persistent Atrial Fibrillation | Atrial Arrhythmia | Atrium; FibrillationUnited Kingdom
-
AtriCure, Inc.Active, not recruitingPersistent Atrial Fibrillation | Atrial Fibrillation (AF) | Longstanding Persistent Atrial FibrillationUnited States
-
Maastricht University Medical CenterRWTH Aachen UniversityUnknownAtrial Fibrillation (Paroxysmal) | Atrial Fibrillation Recurrent | Atrial Fibrillation Common Gene VariantsNetherlands
-
Adagio MedicalRecruitingAtrial Fibrillation | Atrial Flutter | Paroxysmal Atrial Fibrillation | Persistent Atrial FibrillationNetherlands, Germany, Belgium
-
Vivek ReddyEnrolling by invitationAtrial Fibrillation and Flutter | Atrial Flutter Typical | Atrial Fibrillation, Paroxysmal or PersistentUnited States
-
Fundació Institut de Recerca de l'Hospital de la...RecruitingAtrial Arrhythmia | Atrial Fibrillation and Flutter | Atrial Fibrillation RecurrentSpain
-
St. George's Hospital, LondonRecruitingAtrial Fibrillation | Atrial Fibrillation, Persistent | Persistent Atrial Fibrillation | Atrial ArrhythmiaUnited Kingdom
-
R-PharmFSBI "National Medical Research Center of Cardiology named after academician...CompletedAtrial Flutter | Paroxysmal Atrial Fibrillation | Persistent Atrial FibrillationRussian Federation
Clinical Trials on Totally Thoracoscopic PV isolation
-
Meshalkin Research Institute of Pathology of CirculationCompletedAtrial Fibrillation | Arterial HypertensionRussian Federation, United States, Greece
-
Staedtisches Klinikum KarlsruheHeidelberg UniversityCompleted
-
Krasnoyarsk Regional HospitalUnknownPathologic Processes | Heart Diseases | Cardiovascular Diseases | Lung Diseases | Atrial Fibrillation | Arrhythmias, Cardiac | Hypertension, Pulmonary
-
Yonsei UniversityRecruitingParoxysmal Atrial FibrillationKorea, Republic of
-
Deutsches Herzzentrum MuenchenUnknownAtrial FibrillationGermany
-
Maria Cecilia HospitalRecruiting
-
Cardiovascular Research Society, GreeceCompletedAtrial FibrillationRussian Federation, Greece
-
Cardiopulmonary Research Science and Technology...Virginia Commonwealth University; AtriCure, Inc.CompletedAtrial Fibrillation AblationUnited States
-
Meshalkin Research Institute of Pathology of CirculationCompletedAtrial Fibrillation | Hypertension, Resistant to Conventional TherapyRussian Federation, United States
-
Texas Cardiac Arrhythmia Research FoundationCompleted