Ablation Verses Anti-arrhythmic Therapy for Reducing All Hospital Episodes From Recurrent Atrial Fibrillation (AVATAR-AF)

February 20, 2019 updated by: Imperial College London
A streamlined AF ablation procedure done without PV mapping as a daycase is more effective than anti-arrhythmic drugs at reducing all hospital episodes for recurrent atrial fibrillation.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

AVATAR-AF is a multicentre, randomised controlled study comparing a streamlined AVATAR-protocol ablation procedure to anti-arrhythmic therapy in patients with documented paroxysmal AF who are considered to be failing current strategy for AF. A secondary control arm will also compare the AVATAR-protocol to conventional AF ablation. 300 patients who are on no prior anti-arrhythmic, 'pill-in-pocket' or taking regular anti-arrhythmics will be randomised in a 1:1:1 manner to a treatment strategy of either AVATAR-protocol ablation, anti-arrhythmic therapy or conventional AF ablation and followed-up for 1 year.

Study Type

Interventional

Enrollment (Anticipated)

300

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United Kingdom
      • Bournemouth, United Kingdom, BH4 7DW
        • The Royal Bournemouth Hospital
      • Brighton, United Kingdom, BN2 1ES
        • Brighton University Hospital
      • Coventry, United Kingdom, CV2 1EP
        • Coventry University Hospital
      • Eastbourne, United Kingdom
        • Eastbourne District General Hospital
      • Hull, United Kingdom, HU16 5JQ
        • Castle Hill Hospital
      • Leeds, United Kingdom, LS1 3EX
        • Leeds General Infirmary
      • Liverpool, United Kingdom, L14 3PE
        • Liverpool Heart and Chest Hospital
      • London, United Kingdom, W12 0NN
        • Hammersmith Hospital
      • London, United Kingdom, EC1A 7BE
        • St Bartholomew's Hospital
      • Newcastle, United Kingdom, NE7 7DN
        • Freeman Hospital
      • Portsmouth, United Kingdom, PO6 3LY
        • Queen Alexandra Hospital
      • Sheffield, United Kingdom, S5 7AU
        • Sheffield University Hospital
      • Wolverhampton, United Kingdom
        • New Cross Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 80 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Documented paroxysmal atrial fibrillation
  2. Modification or initiation of anti-arrhythmic agent required for symptom control
  3. Males or females eighteen (18) to eighty (80) years of age
  4. Suitable candidate for catheter ablation
  5. Signed informed consent

Exclusion Criteria:

  1. Contraindication to catheter ablation
  2. No carer to enable daycase discharge
  3. Arrhythmias other than AF documented unless they have had curative ablation (eg. for atrial flutter)
  4. No documentation of sinus rhythm within 3 months
  5. Valvular or coronary heart disease needing regular follow up
  6. EF <45% or moderate/severe LV dysfunction
  7. Active gastrointestinal disease
  8. Renal failure with creatinine >200 μmol/L or on dialysis
  9. Active fever or infection
  10. Life expectancy shorter than the trial
  11. Allergy to contrast
  12. Severe cerebrovascular disease
  13. Bleeding or clotting disorders or inability to receive heparin
  14. Uncontrolled diabetes (HbA1c ≥73 mmol/mol or HbA1c ≤64 mmol/mol and Fasting Blood Glucose ≥9.2 mmol/L)
  15. Serum Potassium [K+] <3.5 mmol/L or >5.0 mmol/L
  16. Malignancy needing surgery, chemotherapy or radiotherapy
  17. Pregnancy or women of child-bearing potential not using a highly effective method of contraception
  18. Must not have previous (4 weeks prior to screening) or current participation in another clinical trial with an investigational drug or investigational device
  19. Unable to give informed consent
  20. Uncontrolled thyroid disease defined as abnormal thyroid function tests causing cardiac manifestations within the last 6mths
  21. Unable to attend follow up visits

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

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: Group 3-Conventional AF Ablation
This will involve an ablation procedure carried out in the usual manner. The patient will have three sheaths placed in the leg veins. Catheters will be passed up to the patient's heart from these veins. Two crossing are required into the left atrium. The ablation will involve freeze technology using the Advance Cryoballoon. It will include measuring the electrical signals and may also involve radiofrequency or 'burning' technology in addition.
Procedure: Conventional AF ablation
Conventional ablation procedure
Other Names:
  • Ablation method-surgical
Active Comparator: Group 2-Anti-arrhythmic therapy
Anti-arrhythmic drugs: On the treatment start date the patient will have a new tablet prescribed or a change in the dosage of the medication. The patient will be reviewed at 8wks (visit 1) later to see if the medication is working. If the tablets are working, the patients medication will be left unchanged. If not, an alternative tablet or a higher dose will be used.
Drug: Anti-Arrhythmic therapy

Group 2 will be prescribed medication listed below:

Amiodarone; Dronaderone; Sotalol Beta blockers; Calcium channel blockers; Flecainide; or Propafenone.

You will then be discharged from clinic. A research nurse will contact you by phone to make sure there are no problems and can make hospital appointments if needed.

Other Names:
  • Amiodarone
  • Beta blockers
  • Calcium channel blockers
  • Sotalol
  • Dronaderone
  • Flecainide
  • Propafenone
Experimental: Group 1-AVATAR-AF Ablation Protocol
AF ablation with pulmonary vein isolation. The patient will have two sheaths in their leg veins instead of the usual three sheaths. Catheters will be passed up to the heart from these leg veins. The single crossing into the left atrium will be by the usual method. Veins will be ablated using freeze technology known as the Advance Cryoballoon. After the ablation is completed the patient will have scans on their heart and checks of the leg veins. If all the checks are satisfactory at six hours after the procedure the patient will be allowed to go home on the same day. The patient will be reviewed in clinic in 8 weeks (visit 1) after the procedure and if it has been successful, will be reviewed again a month later (visit 2) and if all is well, the patient will be discharged from clinic.
Procedure: AVATAR-AF ablation
Experimental ablation protocol
Other Names:
  • Ablation method-surgical

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
All hospital episodes (Emergency Room or patient request for OPD) related to treatment for atrial arrhythmia
Time Frame: 12 months
Composite outcome measure
12 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Death or stroke from any cause
Time Frame: 12 months
Composite outcome measure
12 months
Any complications caused by the procedure (pericardial effusion, bleeding >2 units, phrenic nerve palsy and other) or the anti-arrhythmic drug (GI disturbance, skin irritation and other)
Time Frame: 12 months
Composite outcome measure
12 months
All hospital episodes which result in a change in therapy for atrial arrhythmia
Time Frame: 12 months
Composite outcome measure
12 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Imperial College London

Investigators

  • Principal Investigator: Dr. Prapa Kanagaratnam, Imperial College London

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

May 1, 2015

Primary Completion (Actual)

September 30, 2018

Study Completion (Actual)

November 27, 2018

Study Registration Dates

First Submitted

April 24, 2015

First Submitted That Met QC Criteria

May 28, 2015

First Posted (Estimate)

June 2, 2015

Study Record Updates

Last Update Posted (Actual)

February 21, 2019

Last Update Submitted That Met QC Criteria

February 20, 2019

Last Verified

February 1, 2019

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • AVATAR-AF

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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