- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01173809
Effect of Amiodarone on the Procedure Outcome in Long-standing Persistent Atrial Fibrillation Undergoing Pulmonary Vein Antral Isolation (SPECULATE)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Background: Atrial Fibrillation (AF) is the most prevalent sustained clinical arrhythmia encountered in clinical practice. Its prevalence is 0.4-1% in the general population and greater than 8% in individuals >80 years of age. An estimated 2.5million individual in North America and 4.5 million in Europe are affected by AF (1). There are two fundamental principles in the management of AF; 1) anticoagulation to reduce the risk of thromboembolism, 2) ablation therapy or drugs or both to control the arrhythmia (2).
Amiodarone, a potent antiarrhythmic drug, is recommended for both atrial and ventricular arrhythmia. It has a combination of Beta-blockade, calcium-, sodium- and potassium-channel blockade effect. Most importantly, the potassium-channel blockade slows repolarization, causing an increase in the action-potential duration and in the refractoriness of the cardiac musculature (3). As the myocardium remains unresponsive, the premature depolarizations which were previously causing AF are prevented from propagation.
During the ablation procedure, mapping electrograms using circular mapping catheter and provocative maneuvers such as administration of isoproterenol in incremental doses are commonly used to aid in identification of pulmonary vein (PV) and non-PV triggers. In addition, areas with complex fractionated atrial electrograms (CFAE) are identified and eliminated by ablation. In patients with LSP, inclusion of PV and non-PV triggers as ablation targets, improves the procedure outcome.
As Amiodarone increases the refractoriness of the myocardium, it is possible that under the effect of Amiodarone some of the focal triggers could be masked or remain unidentified during mapping or isoproterenol-provocation. These unrecognized triggers could cause recurrence of AF during the post-ablation period. In other words, discontinuation of Amiodarone at least 5-months before ablation could result in unmasking of all the focal triggers that would have otherwise stayed unrecognized and eliminating those triggers would significantly improve the success rate of the procedure.
Our study aims to investigate the role of Amiodarone in influencing the procedure outcome in LSP-AF patients undergoing catheter ablation.
Hypothesis: Withdrawal of Amiodarone 4 months before procedure results in unmasking of additional focal triggers, ablation of which leads to an improved procedure outcome in LSP_AF patients.
Inclusion Criteria:
- History of LSP AF
- Age > 18 years
- Willing and ability to understand and sign an informed consent
- Patients on chronic Amiodarone therapy (≥ 3 months)
Exclusion Criteria:
- Unstable angina
- Concomitant treatment with other class I or III antiarrhythmic drugs
- Myocardial infarction within past 3 months)
- Presence of any disease that is likely to shorten life expectancy to < 1 year
- Symptomatic heart failure, NYHA III or IV
- Contraindications for Amiodarone
- Chronic liver diseases
- Pregnant or breast-feeding mothers
Primary Outcome Measure:
Recurrence of AF, atrial flutter or atrial tachycardia
Secondary Outcome Measures:
Difference in the occurrence of relapse between the control and the study groups
Study design:
This is a multi-center, prospective study in which consecutively enrolled patients treated with Amiodarone for long standing persistent AF will be randomized to either the study or the control group.
Study group: Amiodarone therapy will be stopped at least 4-months before ablation procedure and ablation will be performed off Amiodarone. Patients will not take Amiodarone during the blanking period (8 weeks post-ablation).
Control group: Patient will continue taking Amiodarone before, during and after ablation (8 weeks post-ablation).
After the blanking period, everybody would be off Amiodarone unless they have recurrence. Anti-arrhythmic drugs other than Amiodarone would be tried if patient develops recurrence and repeat ablation would be considered.
Follow-Up:
Patients will be followed up for 3 years post-ablation. An ECG and telemetry transmission monitor report will be obtained in all patients at each follow-up examination.
Patients will be supplied with an Event Recorder for trans-telephonic rhythm transmission (telemetry) for 5 months after ablation, and will be asked to transmit their rhythm data every time they had symptoms compatible with arrhythmias; and at least once a week, even if they were asymptomatic. Holter monitoring will be performed at 6-month post-ablation. The arrhythmic episodes will be documented based on ECG, Holter data, Event Recorder data and/or implanted device data (when available).
In case of recurrence, if patients undergo repeat ablations, all procedures will happen off amiodarone. After redo, patients will be followed up for 1 year for recurrence in the same way as described above.
Study Type
Enrollment (Anticipated)
Phase
- Phase 3
Contacts and Locations
Study Locations
-
-
Texas
-
Austin, Texas, United States, 78705
- St.David's Medical Center
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- History of LSP AF
- Age > 18 years
- Willing and ability to understand and sign an informed consent
- Patients on chronic Amiodarone therapy (≥ 3 months)
Exclusion Criteria:
- Unstable angina
- Concomitant treatment with other class I or III antiarrhythmic drugs
- Myocardial infarction within past 3 months)
- Presence of any disease that is likely to shorten life expectancy to < 1 year
- Symptomatic heart failure, NYHA III or IV
- Contraindications for Amiodarone
- Chronic liver diseases
- Pregnant or breast-feeding mothers
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Control
Patient will continue taking Amiodarone before, during and after catheter ablation (8 weeks post-ablation).
|
Patient will continue taking Amiodarone before, during and after ablation (8 weeks post-ablation).
Amiodarone therapy will be stopped at least 5-months before ablation procedure and ablation will be performed off Amiodarone.
Patients will not take Amiodarone during the blanking period (8 weeks post-ablation).
|
Active Comparator: Study
Amiodarone therapy will be stopped at least 5-months before ablation procedure and ablation will be performed off Amiodarone.
Patients will not take Amiodarone during the blanking period (8 weeks post-ablation).
|
Patient will continue taking Amiodarone before, during and after ablation (8 weeks post-ablation).
Amiodarone therapy will be stopped at least 5-months before ablation procedure and ablation will be performed off Amiodarone.
Patients will not take Amiodarone during the blanking period (8 weeks post-ablation).
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Recurrence of atrial arrhythmia
Time Frame: 1 year
|
Recurrence of AF, atrial flutter or atrial tachycardia
|
1 year
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Relapse of AF
Time Frame: 1 yeay
|
Difference in the occurrence of relapse between the control and the study groups
|
1 yeay
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Andrea Natale, MD, TCAI, St.David's Medical Center
Publications and helpful links
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 (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Pathologic Processes
- Heart Diseases
- Cardiovascular Diseases
- Arrhythmias, Cardiac
- Atrial Fibrillation
- Molecular Mechanisms of Pharmacological Action
- Anti-Arrhythmia Agents
- Vasodilator Agents
- Enzyme Inhibitors
- Membrane Transport Modulators
- Cytochrome P-450 CYP3A Inhibitors
- Cytochrome P-450 Enzyme Inhibitors
- Sodium Channel Blockers
- Cytochrome P-450 CYP2D6 Inhibitors
- Cytochrome P-450 CYP1A2 Inhibitors
- Cytochrome P-450 CYP2C9 Inhibitors
- Potassium Channel Blockers
- Amiodarone
Other Study ID Numbers
- TCAI-SPECULATE
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.
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