Convergent Ablation Plus Left Atrial Appendage Isolation for the Treatment of Persistent Atrial Fibrillation

Persistent Atrial Fibrillation Clinical Trial

— CLIP-AF  

Official title:

Convergent Ablation Plus Left Atrial Appendage Isolation for the Treatment of Persistent Atrial Fibrillation

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT06165510
• Other study ID #: 320553
• Status: Not yet recruiting
• Phase: N/A
• Start date: January 2024
• Est. completion date: October 2025

Study information

• Verified date: December 2023
• Source: Barts & The London NHS Trust
• Contact: Syed Ahsan
• Phone: 020 7377 7000
• Email: syedahsan[@]nhs.net
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

A randomised controlled clinical trial to assess efficacy of convergent ablation with the LARIAT procedure, as compared to standard endocardial catheter ablation in patients with long-standing persistent atrial fibrillation (AF).

Description:

Atrial Fibrillation is the commonest arrhythmia and is a major cause of morbidity and mortality, often causative in ischaemic strokes and compounded by heart failure. Treatment options are limited for persistent long-standing AF (PeAF), with pulmonary vein isolation by endocardial ablation being insufficient and further additive endocardial lesions with repeated ablations yield mixed results resultant in further atrial arrhythmias. Currently success rates for catheter ablation are moderate at 40 to 70% in a single procedure.

If this was improved, patient quality of life and readmission rates would significantly improve as well as a reduction in anti-arrhythmic drug use.

The Convergent procedure - is a two stage minimally invasive hybrid approach. The first stage employs surgical ablation to the posterior wall of the left atrium in combination with the LARIAT procedure to isolate the left atrium appendage (LAA). The second stage involves endocardial catheter ablation to confirm the surgical ablation lesions, and perform further endocardial catheter ablation to leverage both epicardial and endocardial lesions to create durable, transmural lesions.

Patients with long-standing persistent AF will be randomised in a 1:1 ratio to either the Convergent ablation with the LARIAT procedure or the standard endocardial catheter ablation.

This feasibility study would assess recruitment to the trial, safety and efficacy of the Convergent procedure, in combination with a left atrial appendage system.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 48
• Est. completion date: October 2025
• Est. primary completion date: August 2025
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 80 Years

Eligibility

Inclusion Criteria:

• Age > 18 years; < 80 years

• Persistent AF > 1-year duration

• Left atrium size < 6cm

• Pts should be able to provide written informed consent.

Exclusion Criteria:

• Subjects currently enrolled in another investigational study except in case of observational registry with no associated treatments.

• Subject has a reversible cause of AF or transient AF

• Subject is absent of LAA or if the LAA is previously surgically ligated

• Subject has had previous cardiac surgery or abdominal surgery.

• Subject has contraindication to anticoagulation.

• Patients with hypertrophic cardiomyopathy.

• Patients with significant valve disease.

• Subject has had previous catheter or surgical ablation

Related Conditions & MeSH terms

• Arrhythmias, Cardiac
• Atrial Arrhythmia
• Atrial Fibrillation
• Atrial Fibrillation, Persistent
• Atrium; Fibrillation
• Persistent Atrial Fibrillation

Intervention

Device:
• Epicardial AF ablation using AtriCure EPi-Sense-AF Guided Coagulation System with Left Atrial Appendage Exclusion using the AtriCure LARIAT Suture Delivery Device.
2 stage procedure - minimally-invasive epicardial ablation with left atrial appendage exclusion using LARIAT procedure via a subxiphoid incision. This is then combined with endocardial radiofrequency catheter ablation in a separate staged procedure.

Procedure:
• Standard Endocardial Catheter Ablation
Standard percutaneous endocardial catheter ablation of atrial fibrillation

Locations

Country	Name	City	State
United Kingdom	St Bartholomew's Hospital	London

Sponsors (2)

Lead Sponsor	Collaborator
Barts & The London NHS Trust	AtriCure, Inc.

Country where clinical trial is conducted

United Kingdom, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Demonstrate trial feasibility with regards to recruitment rate	Recruitment rate to the Convergent Procedure (with LARIAT) and radiofrequency ablation in the cohort of patients with our specific inclusion criteria will be measured.	24 months
Primary	A composite of major adverse events (MAE) and complications occurring within 30 days post procedure will be measured.	Primary safety endpoint was a composite of major adverse events (MAE) and complications occurring within 30 days post procedure. Any of the following endpoints counted as a MAE: death, stroke/transient ischaemic attack, myocardial infarction, pericarditis requiring pericardiocentesis or prolongation of hospital stay or readmission, cardiac perforation/tamponade, bleeding at vascular access site requiring intervention, pneumothorax requiring intervention (after removal of chest drain, symptomatic pulmonary vein stenosis > 70%, permanent phrenic nerve paralysis, atrio-oesophageal fistula, major vascular complications and infection at surgical or puncture site requiring surgical intervention.	30 days post procedure
Primary	Success or failure at 12 months of persistent AF patients to be free of: Atrial arrhythmia (classed as documentation of atrial fibrillation, atrial flutter or atrial tachycardia lasting for more than 30 seconds)	Recurrence of any atrial arrhythmia > 30 seconds on or off class I / III medications	Measured from the end of a 3 month blanking period to 12 months post procedure
Primary	Measure improvement in symptoms following convergent ablation	Measure change in quality of life through the European Heart Rhythm Association (EHRA) patient survey which categorises patients symptoms during physical activity in 4 categories. The higher the class, the greater the severity of symptoms with Class 1 indication no symptoms and Class 4 indicating disabling symptoms with discontinuation of normal daily activity.	12 months
Secondary	Measure improvement in symptoms following convergent ablation.	To measure improvement in quality of life assessment measured through the Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) questionnaire) to be performed at baseline, 6 months and 12 months post procedure. This survey employs the use of 20 questions regarding symptoms, effect on daily activities, treatment concerns and treatment satisfaction to generate a score from 0 - 100. The lower the score, the more severe the disability with score 0 indicating complete disability and score 100 indicating no disability or limitation in daily activities.	12 months
Secondary	Changes in baseline left ventricular ejection fraction (LVEF) in patients with severe left ventricular systolic dysfunction (EF <35%) will be measured.	Assessment of LVEF via transthoracic echocardiogram at baseline and transthoracic echocardiogram at 12 months post procedure.	12 months
Secondary	Measure improvement in NYHA (New York Heart Association) class in patients with NYHA class III to IV following convergent AF ablation.	Assessment of heart failure symptoms and functional status via clinic review at baseline and 12 months post-procedure.	12 months