Adjunctive Renal Denervation in the Treatment of Atrial Fibrillation (H-FIB)

Adjunctive Renal Denervation to Modify Hypertension and Sympathetic Tone as Upstream Therapy in the Treatment of Atrial Fibrillation

The objective of the H-FIB trial is to determine the role of renal sympathetic denervation in the prevention of Atrial Fibrillation (AF) recurrence in patients with hypertension for whom a catheter-based AF ablation procedure is planned. Patients will be randomized to either AF catheter ablation (usual therapy) or AF catheter ablation plus renal sympathetic denervation.

Study Overview

• Status: Completed
• Conditions: Atrial Fibrillation; Uncontrolled Hypertension
• Intervention / Treatment: Device: Boston Scientific Vessix Renal Denervation System

Detailed Description

The purpose of this study is to examine the potential additional benefit of performing renal sympathetic denervation at the same time as an AF ablation procedure, in order to improve the long-term success of the AF procedure.

To take part in this study, you must meet all study requirements. Screening visit tests and procedures such as a physical exam, blood pressure, review of medical history, blood sample, and a Transthoracic Echocardiogram (TTE) are done to see if you are eligible to be in the study.

Patients who qualify for the study and provide consent will undergo catheter ablation for AF. Very thin electrode catheters, similar to long wires, will be inserted into blood vessels in the groin. Using the ablation catheter, we will "ablate" or damage the tissue adjacent to your pulmonary veins that is not behaving normally.

Immediately following the catheter ablation, patients will undergo a renal angiogram in order to assess suitability for catheter-based renal sympathetic denervation. A renal angiogram is an x-ray study of the blood vessels in the kidney to evaluate for blockage, and abnormalities that could be affecting the blood supply to the kidney. It is performed by injecting contrast dye through a catheter (a tiny tube) into the blood vessels of the kidney.

• Study Type: Interventional
• Enrollment (Actual): 50
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Czechia
  • Prague, Czechia, 15030
    • Na Homolce Hospital
• Russian Federation
  • Novosibirsk, Russian Federation, 630055
    • Siberian Biomedical Research Center Ministry of Health Russian Federation
• United States
  • California
    • Sacramento, California, United States, 95819
      • Regional Cardiology Associates
  • Kansas
    • Kansas City, Kansas, United States, 66160
      • University of Kansas Medical Center
  • Massachusetts
    • Boston, Massachusetts, United States, 02114
      • Massachusetts General Hospital
    • Boston, Massachusetts, United States, 02215
      • Brigham and Women's Hospital
  • New York
    • New York, New York, United States, 10029
      • Mount Sinai Hospital
  • South Carolina
    • Charleston, South Carolina, United States, 29425
      • Medical University of South Carolina

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 85 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Inclusion Criteria
• Age ≥ 18 years of age
• History of AF (paroxysmal or persistent) and planned for a guideline-supported catheter ablation procedure
• History of significant hypertension (defined as SBP ≥160 mm Hg and/or DBP ≥100 mmHg) and receiving treatment with at least one anti-hypertensive medication OR Clinical History of hypertension and receiving treatment with at least two anti-hypertensive medications (specifically for blood pressure reduction).
• Renal vasculature is accessible as determined by intra-procedural renal angiography.
• Ability to understand the requirements of the study
• Willingness to adhere to study restrictions, comply with all post-procedural follow-up requirements and to sign informed consent

Exclusion Criteria

• Inability to undergo AF catheter ablation (e.g., presence of a left atrial thrombus, contraindication to all anticoagulation)
• Prior left atrial ablation for an atrial arrhythmia (before this index procedure)
• Patients with NYHA class IV congestive heart failure
• Individual has known secondary hypertension

• Individual has renal artery anatomy that is ineligible for treatment including:

  1. Inability to access renal vasculature
  2. Main renal arteries < 3 mm in diameter or < 20 mm in length.
  3. Hemodynamically or anatomically significant renal artery abnormality or stenosis in either renal artery which, in the eyes of the operator, would interfere with safe cannulation of the renal artery or meets standards for surgical repair or interventional dilation.
  4. A history of prior renal artery intervention including balloon angioplasty or stenting that precludes a possibility of ablation treatment.
• Individual has an estimated glomerular filtration rate (eGFR) of less than 45mL/min/1.73m2, using the MDRD calculation.
• Individual has a single functioning kidney (either congenitally or iatrogenically).
• Individual is pregnant or nursing.
• Life expectancy <1 year for any medical condition

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: DOUBLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Intervention arm; These subjects will undergo routine catheter ablation of atrial fibrillation PLUS renal sympathetic denervation with the Boston Scientific Vessix Renal Denervation System.	Device: Boston Scientific Vessix Renal Denervation System; Renal sympathetic denervation is modulation of the nerves which run along the renal arteries (the renal sympathetic nerves) with radiofrequency energy. This is the same energy source used to perform your heart ablation. Boston Scientific Vessix Renal Denervation System, Boston Scientific, Inc., Quincy, Massachusetts; Other Names: renal denervation; denervation
NO_INTERVENTION: Control arm; These subjects will undergo routine catheter ablation of atrial fibrillation only.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Anti-arrhythmic Drug (AAD)-Free Single-procedure Freedom From Atrial Fibrillation Recurrence	The primary endpoint of this study is anti-arrhythmic drug (AAD)-free single-procedure freedom from AF recurrence through 12 months (not including a 90 day blanking period).	up to 12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
AAD-free Single-procedure Freedom From AF Recurrence	AAD-free single-procedure freedom from AF recurrence through 24 months (not-including recurrences within the first 90 days of the initial ablation procedure)	up to 24 months
Freedom From AF Recurrence Despite Taking AADs	Freedom from AF recurrence through 24 months (not-including the pre-defined 90 day blanking period) despite taking AADs	up to 24 months
Blood Pressure Control as Compared to Baseline	Blood pressure control between the two groups as compared to baseline at 6 months, 12 months and 24 months.	baseline, 6 months, 12 months, and 24 months
Number of Participants With Major Adverse Cardiac Events (MACE)	Number of Participants with Major adverse cardiac events (MACE) defined as a non-weighted composite score of: death, stroke, CHF hospitalization, and clinically diagnosed thromboembolic events other than stroke and hemorrhage requiring transfusion within 12 months of randomization	within 12 months of randomization
Number of Participants With Serious Adverse Events (SAE)	SAE-any experience that results in a fatality or is life threatening; results in significant or persistent disability; requires or prolongs hospitalization; results in congenital anomaly/birth defect; or represents other significant hazards or potentially serious harm to research subjects or others, in the opinion of the investigators. Important medical events that may not result in above may be considered a SAE when, based upon appropriate medical judgment, they may jeopardize the patient and may require medical or surgical intervention to prevent one of the outcomes listed in this definition	up to 24 months
Left Atrial (LA) Size	LA size by TTE at baseline and at 12 months	at baseline and at 12 months
Ejection Fraction (EF)	Ejection fraction (EF) is a measurement, expressed as a percentage, of how much blood the left ventricle pumps out with each contraction. A normal heart's ejection fraction may be between 50 and 70 percent.	at baseline and at 12 months
Number of Participants With Procedure Adverse Events	Causality will be defined as adverse events that, after careful medical evaluation, are considered with a high degree of certainty to be related to the intervention (AF ablation ± renal sympathetic denervation).	up to 24 months
Number of Anti-hypertensive Medications	Total number of anti-hypertensive medications at study end, compared between the two treatment arms	baseline and 24 months
Atrial Fibrillation Effect on QualiTy-of-life Questionnaire (AFEQT)	The change in quality of life (QoL) from baseline to 12 months as measured by AFEQT, a 20- item instrument. Full range from 0 to 100, with higher score indicates higher level of QoL.	baseline, 12 months and 24 months

Collaborators and Investigators

• Sponsor: Vivek Reddy

Study record dates

Study Major Dates

• Study Start (ACTUAL): September 17, 2012
• Primary Completion (ACTUAL): July 11, 2019
• Study Completion (ACTUAL): July 11, 2019

Study Registration Dates

• First Submitted: July 5, 2012
• First Submitted That Met QC Criteria: July 5, 2012
• First Posted (ESTIMATE): July 10, 2012

Study Record Updates

• Last Update Posted (ACTUAL): November 5, 2020
• Last Update Submitted That Met QC Criteria: October 15, 2020
• Last Verified: October 1, 2020

More Information

Terms related to this study

• Keywords: hypertension; renal sympathetic denervation; renal catheter ablation
• Additional Relevant MeSH Terms: Pathologic Processes; Heart Diseases; Cardiovascular Diseases; Vascular Diseases; Arrhythmias, Cardiac; Hypertension; Atrial Fibrillation
• Other Study ID Numbers: GCO 12-1465

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO