- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02441738
Hybrid Versus Catheter Ablation in Persistent AF (HARTCAP-AF)
Hybrid Thoracoscopic Surgical and Transvenous Catheter Ablation Versus Transvenous Catheter Ablation in Persistent and Longstanding Persistent Atrial Fibrillation
Atrial fibrillation (AF) is the most common cardiac arrhythmia with a lifetime risk of developing AF of 1 in 4 people aged over 40. Besides hemodynamic compromises stroke remains the most feared complication of AF with an increase in risk by 5-fold.
Catheter ablation has evolved as a standardized treatment option in paroxysmal AF. Due to the advanced electrical and structural remodeling the single procedural results of catheter ablation for persistent and longstanding persistent AF are rather disappointing without a proven superiority of any applied strategy compared to others. However, repeated catheter ablation can achieve better results. The surgical (epicardial) approach seems to be more effective, though still a significant amount of failures exist. Checking the epicardial ablation lines and if necessary making additional endocardial lines (which is a hybrid ablation) is expected to be most efficacious in avoiding lesion gaps and providing the most complete lesion set.
The study objective of this pilot trial is to compare the safety and efficacy of catheter ablation within 6 months versus a hybrid ablation consisting of endoscopic epicardial surgery combined with endocardial catheter ablation (performed one-stage) in preventing the recurrence of atrial fibrillation (AF) in symptomatic, drug refractory patients with persistent or longstanding persistent atrial fibrillation.
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Limburg
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Maastricht, Limburg, Netherlands, 6229HX
- Maastricht University Medical Center
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Known with a history of symptomatic persistent AF or longstanding persistent atrial fibrillation,
- Refractory to or intolerant of at least one antiarrhythmic drug class I or III,
- At least 18 years of age,
- Mentally able and willing to give informed consent.
Exclusion Criteria:
- Previous ablation procedure,
- Longstanding persistent AF > 3 years,
- Paroxysmal atrial fibrillation. Successful cardioversion within 48 hours of onset of the arrhythmia will be also considered paroxysmal. In patients with paroxysmal and persistent AF, the dominant pattern should be taken to categorize,
- Atrial fibrillation secondary to electrolyte imbalance, thyroid disease, or other reversible or non-cardiovascular cause,
- Presence of left atrial appendage (LAA) thrombus,
- Left atrial size ≥ 60mm (PLAX-view on TEE),
- Left ventricular ejection fraction < 40%,
- In need for other cardiac surgery then AF treatment within 12 months,
- Intolerance to heparin and warfarin,
- Unable to undergo TEE,
- Sick-sinus-syndrome
- Mitral valve insufficiency > Iº
- Carotic stenosis > 80%,
- Active infection or sepsis,
- Pleural adhesions,
- Elevated hemi diaphragm
- Significant pulmonary dysfunction as assessed by preoperative lung testing,
- Chronic obstructive pulmonary disease with a FEV1 or VC < 50% predicted
- History of cerebrovascular accident (CVA) or transient ischemic attack (TIA),
- History of blood clotting abnormalities,
- History of thoracic radiation,
- History of pericarditis,
- History of cardiac tamponade,
- History of thoracotomy or cardiac surgery,
- Body-mass-index > 40,
- Pregnancy,
- Life expectancy less than 12 months,
- Participation in any other clinical study involving an investigational drug or device.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
ACTIVE_COMPARATOR: Hybrid Ablation
Epicardial surgical ablation performed thoracoscopically with occlusion/removal of the LAA combined with percutaneous endocardial ablation (one-stage).
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The procedure will be performed following standard of care guidelines.
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ACTIVE_COMPARATOR: Catheter Ablation
Percutaneous endocardial catheter ablation, with optional repeated catheter ablation(s).
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The procedure will be performed following standard of care guidelines.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Freedom from any AT off antiarrhythmic drugs class I or III lasting > 5 minutes after the blanking period, evaluated by any ECG-tracing and 7-day holter.
Time Frame: 12 Months
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12 Months
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Major complications during follow-up
Time Frame: 12 Months
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12 Months
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Collaborators and Investigators
Investigators
- Principal Investigator: Mark La Meir, MD, PhD, Maastricht University Medical Center
Publications and helpful links
Study record dates
Study Major Dates
Study Start (ACTUAL)
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
- NL.52951.068.16
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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