December 10, 2020
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January 12, 2021
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February 29, 2024
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March 29, 2021
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July 31, 2023 (Final data collection date for primary outcome measure)
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Time to first recurrence of any atrial tachyarrhythmia [ Time Frame: days 91 to 365 post-ablation ] Time to first recurrence of any atrial tachyarrhythmia (atrial fibrillation [AF], atrial flutter [AFL] or atrial tachycardia [AT]) between days 91 and 365 post ablation as detected on continuous implantable cardiac monitor (ICM). AF, AFL or AT will qualify as a recurrence after ablation if it lasts 120 s or longer on ICM (the minimum programmable episode interval).
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Same as current
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- Number of participants with complications [ Time Frame: days 0 to 30 post-ablation ]
Composite endpoint composed of:
- cardiac tamponade requiring drainage
- persistent phrenic nerve palsy lasting >24 hours
- serious vascular complications requiring intervention
- stroke/TIA
- atrioesophageal fistula
- death
- Total procedure time [ Time Frame: Day 1 ]
procedural endpoint
- Total LA indwelling time [ Time Frame: Day 1 ]
procedural endpoint
- Total cryoablation time [ Time Frame: Day 1 ]
procedural endpoint
- Total number of cryoapplications per patient/per vein [ Time Frame: Day 1 ]
procedural endpoint
- Time to effect [ Time Frame: Day 1 ]
disappearance of PV-Signal; procedural endpoint
- Nadir temperatures [ Time Frame: Day 1 ]
procedural endpoint
- Total fluoroscopy time [ Time Frame: Day 1 ]
procedural endpoint
- Radiation dose [ Time Frame: Day 1 ]
procedural endpoint
- Contrast agent usage [ Time Frame: Day 1 ]
unit measure ml; procedural endpoint
- Proportion of veins with PV signals visible before cryoablation [ Time Frame: Day 1 ]
procedural endpoint
- Rate of Phrenic nerve palsy [ Time Frame: Day 1 ]
procedural endpoint
- Changes in high sensitive Troponin (hsTroponin) [ Time Frame: Day 1 ]
one day 1 post-ablation ; procedural endpoint
- Time to first symptomatic recurrence of atrial tachyarrhythmia [ Time Frame: between 91-365 days after ablation ]
Assessed by the ICM Core Lab. "Symptomatic" is defined as acute onset awareness of palpitations, breathlessness, dizziness, fatigue or chest pain associated with patient activation of the loop recorder. Follow up Endpoint.
- Time to first recurrence of atrial tachyarrhythmia [ Time Frame: between days 1 and 90 after ablation ]
Follow up Endpoint.
- Arrhythmia burden (daily AF burden [hours/day]; overall AF burden = % time in AF) [ Time Frame: between: 0-90 days; 91-365 days , 365 days up to 3.5 years ]
Assessed by the ICM Core Lab post implantation: between 0-90 days; 91-365 days, 365 days to explantation/end of life of the ICM
- Arrhythmia burden calculated for 7-day intervals (daily AF burden [hours/day]; overall AF burden = % time in AF) [ Time Frame: 3, 6 and 12 months follow up ]
Comparison of full-duration ICM derived endpoints with standard clinical practice derived endpoints. Standard clinical practice being defined as 7d-Holter Periods after 3, 6 and 12 months (modelled with random 7day ICM periods after 3, 6 and 12 months). Follow up Endpoint.
- Comparison of the prevalence of the type of arrhythmia [ Time Frame: 3, 12, 24 and 36 months follow up ]
Arrhythmia being AF or organized atrial arrhythmias (Atrial flutter or atrial tachycardias). Follow up Endpoint.
- Proportion of patients admitted to the hospital or emergency room because of documented recurrence of atrial arrhythmias [ Time Frame: postablation 3 months (+/- 2 weeks), 12 months (+/- 2 months), 24 months (+/- 2 months) and 36 months (+/- 2 months) ]
based on telephone follow-up
- Proportion of patients undergoing electrical cardioversion because of documented recurrence of atrial arrhythmias [ Time Frame: postablation 3 months (+/- 2 weeks), 12 months (+/- 2 months), 24 months (+/- 2 months) and 36 months (+/- 2 months) ]
based on telephone follow-up
- Proportion of patients undergoing a repeat ablation procedure because of documented recurrence of atrial arrhythmias [ Time Frame: postablation 3 months (+/- 2 weeks), 12 months (+/- 2 months), 24 months (+/- 2 months) and 36 months (+/- 2 months) ]
based on telephone follow-up
- Number of reconnected veins assessed in study patients undergoing a Redo-Procedure at one of the study centres [ Time Frame: during redo-procedure ]
- Sites (anatomical location) of vein reconnection assessed in study patients undergoing a Redo-Procedure at one of the study centres [ Time Frame: during redo-procedure ]
- Size (area calculate in mm2) of antral scar area assessed in study patients undergoing a Redo-Procedure at one of the study centres [ Time Frame: during redo-procedure ]
- Evolution of Quality of Life (QoL) [ Time Frame: Months 3, 12, 24 and 36 post procedure ]
QoL questionnaires (EQ-5D) will be sent to the patients by mail after 3, 12, 24 and 36 months to compare the evolution of QoL after the ablation
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Same as current
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Not Provided
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Not Provided
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Comparison of PolarX and the Arctic Front Cryoballoons for PVI in Patients With Symptomatic Paroxysmal AF
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Comparison of the PolarX and the Arctic Front Cryoballoon for Pulmonary Vein Isolation in Patients With Symptomatic Paroxysmal Atrial Fibrillation - A Multi-Center Non-Inferiority Design Clinical Trial
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Pulmonary vein isolation (PVI) is an effective treatment for atrial fibrillation (AF). Single shot devices are increasingly used for PVI. Currently, Medtronic Arctic Front cryoballoon is the most frequently used single shot technology and hence is the benchmark for upcoming technologies. A novel cryoballoon technology has recently been introduced (PolarX, Boston Scientific). However, whether PolarX provides effectiveness similar to the standard-of-practice Medtronic Arctic Front cryoballoon is yet to be investigated. Given that PolarX was developed considering the reported limitations and potential failures associated with the Medtronic Arctic Front cryoballoon, it might be even more effective and safe for use in AF ablation procedures.
The aim of this trial is to compare the efficacy and safety of the PolarX Cryoballoon (Boston Scientific) and the Arctic Front Cryoballoon (Medtronic) in patients with symptomatic paroxysmal AF undergoing their first PVI.
This is an investigator-initiated, multicenter, randomized controlled, open-label trial with blinded endpoint adjudication. Given that the Medtronic Arctic Front Cryoballoon is the standard-of-practice for single shot PVI and the PolarX is the novel technology, this trial has a non-inferiority design.
The hypothesis with regards to the primary efficacy endpoint is that the PolarX Cryoballoon (Boston Scientific) shows lower efficacy compared to the Arctic Front Cryoballoon (Medtronic) and that therefore more episodes of first recurrence of any atrial arrhythmia between days 91 and 365 will be observed in patients with symptomatic paroxysmal AF undergoing their first PVI. Hence the alternative hypothesis postulates that the PolarX Cryoballoon is non-inferior to the Arctic Front Cryoballoon. Rejection of the null hypothesis is needed to conclude non-inferiority.
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Not Provided
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Interventional
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Phase 4
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Allocation: Randomized Intervention Model: Parallel Assignment Masking: None (Open Label) Primary Purpose: Treatment
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Paroxysmal Atrial Fibrillation
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- Active Comparator: PVI using the Arctic Front Cryoballoon (Medtronic)
Pulmonary vein isolation using the Arctic Front Cryoballoon (Medtronic)
Intervention: Device: PVI using the Arctic Front Cryoballoon (Medtronic)
- Active Comparator: PVI using the PolarX Cryoballoon (Boston Scientific)
Pulmonary vein isolation using the PolarX Cryoballoon (Boston Scientific)
Intervention: Drug: PVI using the PolarX Cryoballoon (Boston Scientific)
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- Jais P, Cauchemez B, Macle L, Daoud E, Khairy P, Subbiah R, Hocini M, Extramiana F, Sacher F, Bordachar P, Klein G, Weerasooriya R, Clementy J, Haissaguerre M. Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: the A4 study. Circulation. 2008 Dec 9;118(24):2498-505. doi: 10.1161/CIRCULATIONAHA.108.772582. Epub 2008 Nov 24. Erratum In: Circulation. 2009 Sep 8;120(10):e83.
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- Kuck KH, Brugada J, Furnkranz A, Metzner A, Ouyang F, Chun KR, Elvan A, Arentz T, Bestehorn K, Pocock SJ, Albenque JP, Tondo C; FIRE AND ICE Investigators. Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. N Engl J Med. 2016 Jun 9;374(23):2235-45. doi: 10.1056/NEJMoa1602014. Epub 2016 Apr 4.
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- Squara F, Zhao A, Marijon E, Latcu DG, Providencia R, Di Giovanni G, Jauvert G, Jourda F, Chierchia GB, De Asmundis C, Ciconte G, Alonso C, Grimard C, Boveda S, Cauchemez B, Saoudi N, Brugada P, Albenque JP, Thomas O. Comparison between radiofrequency with contact force-sensing and second-generation cryoballoon for paroxysmal atrial fibrillation catheter ablation: a multicentre European evaluation. Europace. 2015 May;17(5):718-24. doi: 10.1093/europace/euv060. Epub 2015 Apr 2.
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- Andrade JG, Champagne J, Dubuc M, Deyell MW, Verma A, Macle L, Leong-Sit P, Novak P, Badra-Verdu M, Sapp J, Mangat I, Khoo C, Steinberg C, Bennett MT, Tang ASL, Khairy P; CIRCA-DOSE Study Investigators. Cryoballoon or Radiofrequency Ablation for Atrial Fibrillation Assessed by Continuous Monitoring: A Randomized Clinical Trial. Circulation. 2019 Nov 26;140(22):1779-1788. doi: 10.1161/CIRCULATIONAHA.119.042622. Epub 2019 Oct 21.
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Active, not recruiting
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201
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200
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July 31, 2025
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July 31, 2023 (Final data collection date for primary outcome measure)
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Inclusion Criteria:
- Paroxysmal atrial fibrillation documented on a 12 lead electrocardiogram (ECG) or Holter monitor (lasting ≥30 seconds) within the last 24 months. According to current guidelines, paroxysmal is defined as any atrial fibrillation (AF) that converts to sinus rhythm within 7 days either spontaneously or by pharmacological or electrical cardioversion.
- Candidate for ablation based on current AF guidelines
- Continuous anticoagulation with warfarin (International Normalized Ratio [INR] 2-3) or a novel oral anticoagulant (NOAC) for ≥4 weeks prior to the ablation; or a transesophageal echocardiogram (TEE) that excludes left atrial (LA) thrombus ≤48 hours before ablation
- Age of 18 years or older on the date of consent
- Informed Consent as documented by signature (Appendix Informed Consent Form)
Exclusion Criteria:
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Sexes Eligible for Study: |
All |
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18 Years and older (Adult, Older Adult)
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No
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Contact information is only displayed when the study is recruiting subjects
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Switzerland
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NCT04704986
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2020-02076
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No
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Studies a U.S. FDA-regulated Drug Product: |
No |
Studies a U.S. FDA-regulated Device Product: |
No |
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Insel Gruppe AG, University Hospital Bern
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Same as current
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Insel Gruppe AG, University Hospital Bern
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Same as current
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University Hospital, Basel, Switzerland
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Principal Investigator: |
Tobias Reichlin, MD |
Inselspital, Bern University Hospital |
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Insel Gruppe AG, University Hospital Bern
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February 2024
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