- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04823299
Patient Specific Ablation Strategy for Atrial Fibrillation (AWARE-2): A Randomized Clinical Trial (AWARE-2)
Ablation Strategy for Paroxysmal Atrial Fibrillation - Trigger and Substrate Guided Wide Area Radiofrequency Ablation Compared to Cryoablation Pulmonary Vein Isolation- Patient Specific Precise Approach to Paroxysmal Atrial Fibrillation Ablation AWARE-2 - Randomized Controlled Trial
Study Overview
Status
Detailed Description
Catheter ablation (CA) for paroxysmal atrial fibrillation (AF) is beset by the significant limitation of recurrent AF in one third of subjects. Subjects with recurrence of AF usually require repeat ablation procedures with the attendant risk of potentially serious complications and significant costs to the health care system. We hypothesize that an innovative, a patient specific precise CA strategy will significantly reduce AF recurrence.
This study will determine whether a precise, patient specific ablation strategy (tailored to the patient's triggers and substrate) combining electrophysiological (EPS) testing guided radiofrequency catheter ablation (RFA) for pulmonary vein isolation (PVI) using the wide-area circumferential (WACA) technique along with non-pulmonary vein trigger (NPVT) and low-voltage area (LVA) ablation will improve freedom from recurrent atrial fibrillation (AF) when compared to PVI alone strategy using cryoballoon ablation (CAB).
The PVI-WACA technique has a 'ceiling effect' due to PV reconnection, especially along the posterior wall of the LA as shown in an observational study investigating the pattern of PV reconnection from our institution. Further attempts at improving durable PVI rates with higher energy ablation may not be possible due to concerns regarding esophageal injury and development of atrio-esophageal fistula. It may be possible to improve the results of CA for paroxysmal AF by targeting NPVT and LVA that are not usually targeted during CA using the PVI-WACA only strategy.
This trial is a single-blinded (subjects blinded), prospective, parallel arm RCT. Subjects satisfying the inclusion and exclusion criteria will be randomized (1:1) to either the control arm (cryoballoon ablation) or the experimental arm (RF based WACA ± electrophysiological testing guided ablation of non-PV triggers of AF and low voltage area ablation). Randomization will be conducted after informed consent has been obtained and before catheter ablation. The first 60 days after catheter ablation will be considered a "blanking-period" and atrial tachyarrhythmias (AF, Atrial Flutter [AFl] or Atrial Tachycardia [AT]) occurring during this period will be documented. However, these will not be considered treatment failures. Subject accrual will occur over a 36-month period and each subject will have a minimum follow-up period of 24 months, with a total trial duration of 60-months. Subjects will be followed up at 2,6,12,18 and 24 months after ablation, with an implantable loop recorder (ILR) interrogation. Quality of life questionnaires (EQ-5D, AFEQT questionnaires and CCS-SAF scale) will be administered at baseline,12-months and 24 months post ablation visit. A tool to assist in decision making will be administered to subjects during the consent process.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Girish Nair, MD
- Phone Number: 613-696-7272
- Email: GNair@ottawaheart.ca
Study Contact Backup
- Name: Sonya Jancar
- Phone Number: 19678 6139797000
- Email: sjancar@ottawaheart.ca
Study Locations
-
-
Ontario
-
Ottawa, Ontario, Canada, K1Y 4W7
- University of Ottawa Heart Institute
-
Contact:
- Girish Nair, MD
- Email: GNair@ottawaheart.ca
-
Principal Investigator:
- Girish Nair, MD
-
-
Quebec
-
Montreal, Quebec, Canada, H3G 1A4
- McGill University Health center
-
Contact:
- Vidal Essebag, MD
- Email: vidal.essebag@mcgill.ca
-
Principal Investigator:
- Vidal Essebag, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age ≥18 years on the date of consent for the trial.
- Subjects must have Paroxysmal AF with at least two episodes of AF over the past 12 months; Early Persistent AF- at least two episodes of AF.
- At least one episode of AF documented on 12-lead ECG, Holter monitor, Trans- telephonic monitor (TTM) or Loop Recorder.
- Subjects must be able to provide informed consent.
Exclusion Criteria:
- Persistent and permanent AF
- History of previous catheter or surgical ablation for AF, AFl, AT, AVNRT, AVRT.
- Documented AVNRT, AVRT, AT or Atrial Flutter prior to enrolment in the trial.
- Previous left atrial (LA) ablation or LA surgery.
- Previous pulmonary vein stenosis or pulmonary vein stent.
- Pre-existing hemi-diaphragmatic paralysis.
- Active intracardiac thrombus.
- Contraindication to systemic oral anticoagulation therapy or radiocontrast materials.
- Current immunosuppressant therapy (corticosteroids, biologic immunomodulators; such patients may be considered if they can safely discontinue immunosuppressants for three months prior to and for three months following catheter ablation).
- Reversible causes of AF (eg. uncontrolled hyperthyroidism, within six months of cardiac surgery).
- Left ventricular ejection fraction <35%.
- NYHA Class 3-4 heart failure.
- Hypertrophic cardiomyopathy with septal or posterior LV wall thickness of >1.8 cm.
- Significant valve disease (moderate or severe mitral/aortic stenosis or regurgitation).
- Known adverse reaction to adenosine.
- Significant chronic kidney disease (eGFR <30ml/min/1.73m2).
- Significant congenital heart disease (including atrial septal defects or pulmonary vein abnormalities; however, subjects with patent foramen ovale will not be excluded).
- Pregnant subjects.
- Cerebral ischemic event (stroke or transient ischemic attack) in the six months prior to consenting for the trial.
- Life expectancy less than one-year.
- Currently participating or anticipated to participate in clinical trials of drug, device or biologic agents that could affect the results of this trial.
- Unwilling or unable to comply fully with study procedures and follow-up.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Cryoballoon ablation
Cryoballoon Pulmonary Vein Isolation-Wide area circumferential ablation (WACA)
|
Cryoballoon pulmonary vein isolation ablation
|
Experimental: RF based WACA ± EP testing guided ablation of non-PV triggers of AF and low voltage area ablation
Radiofrequency wide area circumferential ablation (WACA) ± electrophysiological testing guided ablation of non-pulmonary vein triggers of AF and low voltage area ablation
|
RF based WACA ± electrophysiological testing guided ablation of non-PV triggers of AF and low voltage area ablation
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Freedom from atrial fibrillation, atrial flutter or atrial tachycardia
Time Frame: 61 to 365 days after ablation
|
AF, AFl or AT, symptomatic or asymptomatic lasting ≥ 30 seconds
|
61 to 365 days after ablation
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Atrial fibrillation burden
Time Frame: 760 days
|
Total duration of AF recorded on ambulatory monitoring/total duration of monitoring
|
760 days
|
Long-term rate of documented AF, AFl or AT
Time Frame: 760 days
|
Long-term rate of documented AF, AFl or AT lasting ≥ 30 seconds
|
760 days
|
Incidence of any ECG/ILR documented AF, AFl or AT
Time Frame: First 60 days after catheter ablation
|
Incidence of any ECG/ILR documented AF, AFl or AT (symptomatic or asymptomatic; lasting ≥ 30 seconds
|
First 60 days after catheter ablation
|
Ablation procedure duration
Time Frame: On day of ablation
|
Catheter ablation procedure time
|
On day of ablation
|
Fluoroscopic exposure
Time Frame: On day of ablation
|
Total Air Kerma (mGy)
|
On day of ablation
|
Fluoroscopic exposure dose
Time Frame: On day of ablation
|
Dose Area Protocol (Gy.cm2)
|
On day of ablation
|
Procedure Related Complications
Time Frame: 760 days
|
Stroke, PV stenosis, pericarditis, phrenic nerve palsy, cardiac perforation, atrio-esophageal fistula, major bleeding and/or death.
|
760 days
|
Emergency room visits or hospitalization due to recurrent AF, AFl or AT
Time Frame: 760 days
|
Emergency room visits or hospitalization due to recurrent AF, AFl or AT
|
760 days
|
Repeat catheter ablation for AF, AFl or AT
Time Frame: 760 days
|
Repeat catheter ablation for AF, AFl or AT
|
760 days
|
Quality of life scale
Time Frame: 12 and 24 months
|
EQ-5D
|
12 and 24 months
|
Quality of life questionnaire
Time Frame: 12 and 24 months
|
AFEQT questionnaire
|
12 and 24 months
|
Quality of life SAF scale
Time Frame: 12 and 24 months
|
CCS-SAF scale
|
12 and 24 months
|
Collaborators and Investigators
Investigators
- Principal Investigator: Girish Nair, MD, Ottawa Heart Institute Research Corporation
Study record dates
Study Major Dates
Study Start (Estimated)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
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
- v21022021
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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