PIFPAF-PFA-undersøgelsen (PIFPAF-PFA)
Lungeveneisolation med pulseret feltablation med versus uden posterior vægablation hos patienter med symptomatisk vedvarende atrieflimren - et multicenter randomiseret klinisk forsøg: PIFPAF-PFA-undersøgelsen
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Undersøgelsestype
Undersøgelsestype
Tilmelding (Faktiske)
Tilmelding
Fase
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Laurent Roten, MD
- Telefonnummer: +41 31 632 52 63
- E-mail: Laurent.Roten@insel.ch
Studiesteder
-
-
-
Baden, Schweiz
- Cantonal Hospital Baden
-
Basel, Schweiz
- University Hospital Basel
-
Bern, Schweiz, 3010
- Inselspital, University Hospital Bern
-
Lausanne, Schweiz, 1011
- University Hospital Lausanne
-
Sankt Gallen, Schweiz
- Cantonal Hospital St. Gallen
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Zurich, Schweiz
- University Hospital Zurich
-
-
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
- Voksen
- Ældre voksen
Tager imod sunde frivillige
Beskrivelse
Inklusionskriterier:
- Vedvarende atrieflimren dokumenteret på et 12-aflednings EKG, Holter-monitor eller implanterbart hjerteapparat inden for de sidste 2 år efter tilmelding
- Vedvarende atrieflimren er defineret som en vedvarende episode, der varer > 7 dage
- Kandidat til ablation ud fra gældende retningslinjer for atrieflimren
- Kontinuerlig antikoagulering med vitamin-K-antagonister eller en NOAC i ≥4 uger før ablationen; eller en transesophageal ekkokardiografi og/eller CT-skanning, der udelukker venstre atriel trombe ≤48 timer før ablationsproceduren
- Alder på 18 år eller ældre på datoen for informeret samtykke
- Underskrevet informeret samtykke
Ekskluderingskriterier:
- Tidligere venstre atriel ablation eller venstre atriel kirurgi
- Venstre atriel diameter >60 mm i den parasternale langakse
- Patienter med paroxysmal atrieflimren
- Patienter med vedvarende atrieflimren, der varer >3 år
- AF på grund af reversible årsager (f.eks. hyperthyroidisme, kardiothoraxkirurgi)
- Intrakardial trombe
- Eksisterende lungevenestenose eller pulmonal venestent
- Allerede eksisterende hemidiaphragmatisk lammelse
- Kontraindikation til antikoagulation eller radiokontrastmaterialer
- Tidligere mitralklapoperation
- Svær mitral regurgitation eller moderat/svær mitral stenose
- Myokardieinfarkt i 3-månedersperioden forud for samtykkedatoen
- Igangværende tredobbelt antitrombotisk/antikoagulationsbehandling
- Hjertekirurgi i 3-måneders intervallet forud for datoen for informeret samtykke eller planlagt hjertekirurgi/transkateter aortaklapimplantation
- Betydelig medfødt hjertefejl (herunder atrielle septaldefekter eller lungeveneabnormiteter, men ikke inklusive en patenteret foramen ovale)
- NYHA klasse III eller IV kongestiv hjerteinsufficiens
- Venstre ventrikel ejektionsfraktion (LVEF) <35 %
- Hypertrofisk kardiomyopati (vægtykkelse >1,5 cm)
- Signifikant kronisk nyresygdom (eGFR <30 ml/min)
- Ukontrolleret hyperthyroidisme
- Cerebral iskæmisk hændelse (slagtilfælde eller TIA) i 6-måneders intervallet forud for datoen for informeret samtykke
- Løbende systemiske infektioner
- Historie om kryoglobulinæmi
- Hjerte amyloidose
- Graviditet (for at udelukke graviditet udføres en blodprøve (HCG) hos kvinder < 50 år før inklusion)
- Forventet levetid mindre end et år pr. lægeudtalelse
- Deltager i øjeblikket i ethvert andet klinisk forsøg, hvilket kan forvirre resultaterne af dette forsøg
- Uvillig eller ude af stand til fuldt ud at overholde undersøgelsesprocedurerne og opfølgningen
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Ingen (Åben etiket)
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Aktiv komparator: Pulmonal veneisolation uden bagvægsablation
Pulmonal veneisolering uden venstre atriel bagvægsablation
|
Pulmonal veneisolation med Pulseret feltablation uden venstre atriel bagvægsablation.
Ved afslutningen af proceduren vil en implanterbar hjertemonitor blive implanteret med henblik på kontinuerlig arytmimonitorering
|
|
Aktiv komparator: Pulmonal veneisolering med bagvægsablation
Isolering af lungevene med ablation af venstre atrial bagvæg
|
Pulmonal veneisolation med Pulseret feltablation med venstre atriel bagvægsablation.
Ved afslutningen af proceduren vil en implanterbar hjertemonitor blive implanteret med henblik på kontinuerlig arytmimonitorering
|
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Time to first recurrence of any atrial tachyarrhythmia day 91-365
Tidsramme: Day 91-365 post-ablation
|
Time to first recurrence of atrial tachyarrhythmia (atrial fibrillation [AF], atrial flutter [AFL] or atrial tachycardia [AT]) between day 91 and 365 post ablation as detected on an implantable cardiac monitor (ICM).
AF, AFL or AT will qualify as a recurrence after ablation if it lasts 120 seconds or longer on the ICM (the minimum programmable episode interval)
|
Day 91-365 post-ablation
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Post-ablation 3D elektroanatomisk kortlægning: Andel af isolerede vener
Tidsramme: Dag 0, kort efter ablation
|
Procedurelt endepunkt
|
Dag 0, kort efter ablation
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|
Antal genforbundne lungevener vurderet under genindgrebsprocedurer
Tidsramme: Under gentagelsesprocedurer mellem dag 1 til 36 måneder efter ablation
|
Sekundært endepunkt under opfølgning
|
Under gentagelsesprocedurer mellem dag 1 til 36 måneder efter ablation
|
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Steder for genforbindelse (anterior, posterior, superior, inferior) af lungevenerne evalueret under genoptagelsesprocedurer
Tidsramme: Under gentagelsesprocedurer mellem dag 1 til 36 måneder efter ablation
|
Sekundært endepunkt under opfølgning
|
Under gentagelsesprocedurer mellem dag 1 til 36 måneder efter ablation
|
|
Størrelsen af det antrale arareal (cm²) af lungevenerne vurderet under genoptagelsesprocedurer
Tidsramme: Under gentagelsesprocedurer mellem dag 1 til 36 måneder efter ablation
|
Sekundært endepunkt under opfølgning
|
Under gentagelsesprocedurer mellem dag 1 til 36 måneder efter ablation
|
|
Antal genforbundne bagvægge evalueret under genindgrebsprocedurer
Tidsramme: Under gentagelsesprocedurer mellem dag 1 til 36 måneder efter ablation
|
Sekundært endepunkt under opfølgning
|
Under gentagelsesprocedurer mellem dag 1 til 36 måneder efter ablation
|
|
Steder for genforbindelse af den bagerste væg evalueret under genindgrebsprocedurer
Tidsramme: Under gentagelsesprocedurer mellem dag 1 til 36 måneder efter ablation
|
Sekundært endepunkt under opfølgning
|
Under gentagelsesprocedurer mellem dag 1 til 36 måneder efter ablation
|
|
Størrelsen af arområdet (cm²) af den bageste væg vurderet under genindgreb
Tidsramme: Under gentagelsesprocedurer mellem dag 1 til 36 måneder efter ablation
|
Sekundært endepunkt under opfølgning
|
Under gentagelsesprocedurer mellem dag 1 til 36 måneder efter ablation
|
|
Percentage of time with cardiac arrhythmia (arrhythmia burden) for each participant between day 91-365 evaluated based on continuous ICM
Tidsramme: Day 91-365 post-ablation
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Key secondary efficacy endpoint
|
Day 91-365 post-ablation
|
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Treatment-emergent adverse events: Cardiac tamponade requiring drainage
Tidsramme: Day 0-90 post-ablation
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Number of patients with cardiac tamponade requiring drainage after PVI
|
Day 0-90 post-ablation
|
|
Treatment-emergent adverse events: Persistent phrenic nerve palsy lasting >24 hours
Tidsramme: Day 0-90 post-ablation
|
Number of patients with persistent phrenic nerve palsy lasting >24 hours after PVI
|
Day 0-90 post-ablation
|
|
Treatment-emergent adverse events: Serious vascular complication requiring intervention
Tidsramme: Day 0-90 post-ablation
|
Number of patients with serious vascular complications requiring intervention after PVI
|
Day 0-90 post-ablation
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Treatment-emergent adverse events: Stroke or TIA
Tidsramme: Day 0-90 post-ablation
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Number of patients with stroke or TIA after PVI
|
Day 0-90 post-ablation
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Treatment-emergent adverse events: Atrioesophageal fistula
Tidsramme: Day 0-90 post-ablation
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Number of patients with atrioesophageal fistula after PVI
|
Day 0-90 post-ablation
|
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Treatment-emergent adverse events: Death
Tidsramme: Day 0-90 post-ablation
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Number of patients with fatal outcome/death after PVI
|
Day 0-90 post-ablation
|
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Time to first recurrence of any atrial tachyarrhythmia day 0-365
Tidsramme: Day 0-365 post-ablation
|
Time to first recurrence of atrial tachyarrhythmia (atrial fibrillation [AF], atrial flutter [AFL] or atrial tachycardia [AT]) between day 91 and 365 post ablation as detected on an implantable cardiac monitor (ICM).
AF, AFL or AT will qualify as a recurrence after ablation if it lasts 120 seconds or longer on the ICM (the minimum programmable episode interval)
|
Day 0-365 post-ablation
|
|
Time to first recurrence of any atrial tachyarrhythmia day 0-90
Tidsramme: Day 0-90 post-ablation
|
Time to first recurrence of atrial tachyarrhythmia (atrial fibrillation [AF], atrial flutter [AFL] or atrial tachycardia [AT]) between day 91 and 365 post ablation as detected on an implantable cardiac monitor (ICM).
AF, AFL or AT will qualify as a recurrence after ablation if it lasts 120 seconds or longer on the ICM (the minimum programmable episode interval)
|
Day 0-90 post-ablation
|
|
Total procedure time
Tidsramme: Day 0, during procedure
|
Procedural endpoint; [min]
|
Day 0, during procedure
|
|
Total left atrial indwelling time
Tidsramme: Day 0, during procedure
|
Procedural endpoint; [min]
|
Day 0, during procedure
|
|
Total fluoroscopy time
Tidsramme: Day 0, during procedure
|
Procedural endpoint; [min]
|
Day 0, during procedure
|
|
Total radiation dose
Tidsramme: Day 0, during procedure
|
Procedural endpoint; Calculated by multiplying the absorbed radiation dose (air kerma) by the cross-sectional area of the X-ray beam [cG*cm2]
|
Day 0, during procedure
|
|
Change in hs-troponin on Day 1 post-ablation compared with pre-procedural hs-troponin
Tidsramme: Pre-procedural (day -1 or day 0) to day 1 post-ablation
|
Procedural endpoint; [ng/L]
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Pre-procedural (day -1 or day 0) to day 1 post-ablation
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Post-ablation 3D electro-anatomical mapping: Posterior wall ablation success rate
Tidsramme: Day 0, shortly after ablation
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Procedural endpoint; experimental group only
|
Day 0, shortly after ablation
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Percentage of time with cardiac arrhythmia (arrhythmia burden) for each participant between day 0-90 evaluated based on continuous ICM
Tidsramme: Day 0-90 post-ablation
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Secondary endpoint during follow-up
|
Day 0-90 post-ablation
|
|
Percentage of time with cardiac arrhythmia (arrhythmia burden) for each participant between day 0-365 evaluated based on continuous ICM
Tidsramme: Day 0-365 post-ablation
|
Secondary endpoint during follow-up
|
Day 0-365 post-ablation
|
|
Percentage of time with cardiac arrhythmia (arrhythmia burden) for each participant between day 365 until explantation or end of life (EOL) of the ICM
Tidsramme: Day 365 post-ablation to explantation of ICM or end of life of ICM (up to 4 years after implantation of ICM)
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Secondary endpoint during follow-up
|
Day 365 post-ablation to explantation of ICM or end of life of ICM (up to 4 years after implantation of ICM)
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Correlation of AF burden to symptoms and quality of life changes
Tidsramme: Day 0-365 post-ablation
|
Secondary endpoint during follow-up; Quality of life will be measured with the EQ-5D-5L questionnaire where higher scores mean better outcomes; Symptoms will be measured with the AFEQT (Atrial Fibrillation Effect on Quality-of-life) questionnaire where higher scores mean worse outcomes
|
Day 0-365 post-ablation
|
|
Time to first recurrence of atrial flutter/ atrial tachycardia day 91-365
Tidsramme: Day 91-365 post-ablation
|
Secondary endpoint during follow-up
|
Day 91-365 post-ablation
|
|
Time to first recurrence of atrial flutter/ atrial tachycardia day 0-90
Tidsramme: Day 0-90 post-ablation
|
Secondary endpoint during follow-up
|
Day 0-90 post-ablation
|
|
Time to first recurrence of atrial flutter/ atrial tachycardia day 0-365
Tidsramme: Day 0-365 post-ablation
|
Secondary endpoint during follow-up
|
Day 0-365 post-ablation
|
|
Time to first recurrence of persistent or paroxysmal atrial fibrillation day 91-365
Tidsramme: Day 91-365 post-ablation
|
Secondary endpoint during follow-up
|
Day 91-365 post-ablation
|
|
Time to first recurrence of persistent or paroxysmal atrial fibrillation day 0-90
Tidsramme: Day 0-90 post-ablation
|
Secondary endpoint during follow-up
|
Day 0-90 post-ablation
|
|
Time to first recurrence of persistent or paroxysmal atrial fibrillation day 0-365
Tidsramme: Day 0-365 post-ablation
|
Secondary endpoint during follow-up
|
Day 0-365 post-ablation
|
|
Average heart rate as recorded by the ICM in months 1, 2 and 3 after ablation
Tidsramme: Months 1, 2 and 3 post-ablation
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Secondary endpoint during follow-up
|
Months 1, 2 and 3 post-ablation
|
|
Hospital or emergency room admission due to atrial arrhythmia recurrence
Tidsramme: Day 0-365 post-ablation
|
Incidence rate
|
Day 0-365 post-ablation
|
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Repeat ablation due to recurrence of atrial arrhythmias
Tidsramme: Day 0-365 post-ablation
|
Incidence rate
|
Day 0-365 post-ablation
|
|
Electrical cardioversion due to recurrence
Tidsramme: Day 0-365 post-ablation
|
Incidence rate
|
Day 0-365 post-ablation
|
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Reinitiation or continuation of antiarrhythmic drug therapy day 91-365
Tidsramme: Day 0-365 post-ablation
|
Incidence rate
|
Day 0-365 post-ablation
|
|
EQ-5D-5L Composite score month 3
Tidsramme: Day 90 post-ablation
|
Quality of life wil be measured with the EQ-5D-5L questionnaire where higher scores mean better outcomes.
Composite score month 3.
|
Day 90 post-ablation
|
|
EQ-5D-5L Composite score month 12
Tidsramme: Day 365 post-ablation
|
Quality of life wil be measured with the EQ-5D-5L questionnaire where higher scores mean better outcomes.
Composite score month 12.
|
Day 365 post-ablation
|
|
EQ-5D-5L Visual analogue scale month 3
Tidsramme: Day 90 post-ablation
|
Quality of life wil be measured with the EQ-5D-5L questionnaire where higher scores mean better outcomes.
Visual analogue scale month 3.
|
Day 90 post-ablation
|
|
EQ-5D-5L Visual analogue scale month 12
Tidsramme: Day 365 post-ablation
|
Quality of life wil be measured with the EQ-5D-5L questionnaire where higher scores mean better outcomes.
Visual analogue scale month 12.
|
Day 365 post-ablation
|
|
AFEQT month 3
Tidsramme: Day 90 post-ablation
|
Quality of life wil be measured with the AFEQT questionnaire.
|
Day 90 post-ablation
|
|
AFEQT month 12
Tidsramme: Day 365 post-ablation
|
Quality of life wil be measured with the AFEQT questionnaire.
|
Day 365 post-ablation
|
|
Stroke or transient ischemic attack day 0-365
Tidsramme: Day 0-365 post-ablation
|
Incidence rate
|
Day 0-365 post-ablation
|
|
All-cause death day 0-365
Tidsramme: Day 0-365 post-ablation
|
Incidence rate
|
Day 0-365 post-ablation
|
|
Time to first episode of atrial tachyarrhythmia day 91-365 lasting ≥1 hour
Tidsramme: Day 91-365 post-ablation
|
Time to first recurrence of atrial tachyarrhythmia (atrial fibrillation [AF], atrial flutter [AFL] or atrial tachycardia [AT]) between day 91 and 365 post ablation as detected on an implantable cardiac monitor (ICM).
AF, AFL or AT will qualify as a recurrence after ablation if it lasts 120 seconds or longer on the ICM (the minimum programmable episode interval)
|
Day 91-365 post-ablation
|
|
Time to first episode of atrial tachyarrhythmia day 91-365 lasting ≥6 hour
Tidsramme: Day 91-365 post-ablation
|
Time to first recurrence of atrial tachyarrhythmia (atrial fibrillation [AF], atrial flutter [AFL] or atrial tachycardia [AT]) between day 91 and 365 post ablation as detected on an implantable cardiac monitor (ICM).
AF, AFL or AT will qualify as a recurrence after ablation if it lasts 120 seconds or longer on the ICM (the minimum programmable episode interval)
|
Day 91-365 post-ablation
|
|
Time to first episode of atrial tachyarrhythmia day 91-365 lasting ≥1 day
Tidsramme: Day 91-365 post-ablation
|
Time to first recurrence of atrial tachyarrhythmia (atrial fibrillation [AF], atrial flutter [AFL] or atrial tachycardia [AT]) between day 91 and 365 post ablation as detected on an implantable cardiac monitor (ICM).
AF, AFL or AT will qualify as a recurrence after ablation if it lasts 120 seconds or longer on the ICM (the minimum programmable episode interval)
|
Day 91-365 post-ablation
|
|
Time to first episode of atrial tachyarrhythmia day 91-365 lasting ≥2 days
Tidsramme: Day 91-365 post-ablation
|
Time to first recurrence of atrial tachyarrhythmia (atrial fibrillation [AF], atrial flutter [AFL] or atrial tachycardia [AT]) between day 91 and 365 post ablation as detected on an implantable cardiac monitor (ICM).
AF, AFL or AT will qualify as a recurrence after ablation if it lasts 120 seconds or longer on the ICM (the minimum programmable episode interval)
|
Day 91-365 post-ablation
|
|
Time to first episode of atrial tachyarrhythmia day 91-365 lasting ≥7 days
Tidsramme: Day 91-365 post-ablation
|
Time to first recurrence of atrial tachyarrhythmia (atrial fibrillation [AF], atrial flutter [AFL] or atrial tachycardia [AT]) between day 91 and 365 post ablation as detected on an implantable cardiac monitor (ICM).
AF, AFL or AT will qualify as a recurrence after ablation if it lasts 120 seconds or longer on the ICM (the minimum programmable episode interval)
|
Day 91-365 post-ablation
|
Andre resultatmål
Andre resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Time to first recurrence of any atrial tachyarrhythmia in patients with versus without left atrial posterior wall scar
Tidsramme: Day 91-365 post-ablation
|
Subgroup analysis; Scar is based on the 3D pre-ablation voltage map at baseline
|
Day 91-365 post-ablation
|
|
Time to first recurrence of any atrial tachyarrhythmia in female versus male patients
Tidsramme: Day 91-365 post-ablation
|
Subgroup analysis
|
Day 91-365 post-ablation
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Efterforskere
Efterforskere
- Ledende efterforsker: Laurent Roten, MD, Inselspital, University Hospital Bern
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Faktiske)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- 2023-00885
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
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