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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT04198701
Registration number
NCT04198701
Ethics application status
Date submitted
10/12/2019
Date registered
13/12/2019
Date last updated
20/02/2024
Titles & IDs
Public title
Pulsed Field Ablation to Irreversibly Electroporate Tissue and Treat AF
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Scientific title
Pulsed Field Ablation to Irreversibly Electroporate Tissue and Treat AF
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Secondary ID [1]
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PULSED AF
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Universal Trial Number (UTN)
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Trial acronym
PULSED AF
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Atrial Fibrillation
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Condition category
Condition code
Cardiovascular
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Other cardiovascular diseases
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Devices - Medtronic PulseSelect Pulsed Field Ablation (PFA) System
Experimental: Pilot - First group of patients enrolled in the study.
Experimental: Pivotal - Roll-In - First patient treated by each physician in the pivotal phase.
Experimental: Pivotal - Paroxysmal AF - Non roll-in patients with paroxysmal AF (intermittent AF).
Experimental: Pivotal - Persistent AF - Non roll-in patients with persistent AF (AF that lasts longer than 7 days).
Treatment: Devices: Medtronic PulseSelect Pulsed Field Ablation (PFA) System
Adult subjects with a history of drug refractory recurrent symptomatic atrial fibrillation (AF) will undergo ablation of pulmonary veins and confirmation of entrance block and, where assessable, exit block with the PulseSelect PFA System.
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Intervention code [1]
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Treatment: Devices
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Safety: Number of Participants With at Least One Primary Safety Event
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Assessment method [1]
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Primary safety events are:
Within 6 months post-ablation:
* Pulmonary vein stenosis (=70% diameter reduction)
* Phrenic nerve injury/diaphragmatic paralysis (ongoing at 6 months)
* Atrioesophageal fistula
Within 30 days of ablation procedure:
* Cardiac tamponade/perforation
* Cerebrovascular accident
* Major bleeding requiring transfusion
* Myocardial infarction
* Pericarditis requiring intervention
* Transient ischemic attack
* Vagal nerve injury resulting in esophageal dysmotility or gastroparesis
* Vascular access complications requiring intervention
* Systemic/pulmonary embolism requiring intervention
* Pulmonary edema
* Death
* Any PulseSelect PFA System-related or PFA procedure-related cardiovascular and/or pulmonary adverse event that prolongs or requires hospitalization for more than 48 hours (excluding recurrent AF/AFL/AT)
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Timepoint [1]
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up to 6 months
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Primary outcome [2]
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Effectiveness: Number of Participants With Treatment Success.
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Assessment method [2]
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Treatment success is defined as freedom from treatment failure. The study requires 24-hour Holter monitoring at 6 and 12 months in addition to weekly and symptomatic patient activated ambulatory monitoring transmissions through 12 months, and 12-lead ECGs at all follow up visits. Treatment failure is defined as any of the following components:
* Acute procedural failure
* Documented AF/AT/AFL on Holter/patient activated ambulatory monitoring/12-lead ECG after the 90-day post-ablation blanking period.
* Any subsequent AF surgery or ablation in the left atrium, except for one repeat PVI ablation using PFA within the 90-day blanking period.
* Direct current cardioversion for atrial tachyarrhythmia recurrences after the 90-day blanking period.
* Class I or III antiarrhythmic drug (AAD) dose increase from the historic maximum ineffective dose (prior to the ablation procedure) or initiation of a new Class I or III AAD after the 90-day blanking period.
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Timepoint [2]
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up to 12 months
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Secondary outcome [1]
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Quality of Life - Change in EQ-5D Score
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Assessment method [1]
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Change in EQ-5D score (12-month score - baseline score). The Euroqol EQ-5D questionnaire (5L version) is a standardized instrument for measuring general health status. The Euroqol EQ-5D questionnaire (which consists of a 5-question survey and a visual analog scale) has a composite score based on the 5-question survey that ranges from 0 (least healthy) to 1 (most healthy).
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Timepoint [1]
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Baseline to 12 months post-ablation
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Secondary outcome [2]
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Quality of Life - Change in AFEQT Score
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Assessment method [2]
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Change in AFEQT score (12-month score - baseline score). The AFEQT questionnaire is an atrial fibrillation (AF) specific health-related quality of life questionnaire to assess the impact of AF on a subject's life. The overall score ranges from 0 - 100, with 0 corresponding to complete disability and 100 corresponding to no disability
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Timepoint [2]
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Baseline to 12 months post-ablation
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Eligibility
Key inclusion criteria
1. Failure of at least one AAD (class I or III) for AF as evidenced by recurrent symptomatic AF, or intolerable side effects due to AAD.
2. A diagnosis of recurrent symptomatic paroxysmal or persistent AF:
1. Symptomatic paroxysmal AF, which is defined as AF that terminates spontaneously or with intervention within 7 days of onset, documented by the following:
1. physician's note indicating at least 2 symptomatic paroxysmal AF episodes occurring within 6 months prior to enrollment; and
2. at least 1 ECG documented AF episode from any form of rhythm monitoring within 12 months prior to enrollment OR
2. Symptomatic persistent AF, which is defined as continuous AF sustained beyond 7 days and less than 1 year, documented by the following:
1. physician's note indicating at least 1 symptomatic persistent AF episode occurring within 6 months prior to enrollment; and
2. any 24-hour continuous ECG recording documenting continuous AF within 6 months prior to enrollment; OR 2 ECGs from any form of rhythm monitoring taken at least 7 days apart, both showing continuous AF within 6 months prior to enrollment
3. Age 18 through 80 years old (or older than 18 if required by local law)
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Minimum age
18
Years
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Maximum age
80
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
1. Long-standing persistent AF (continuous AF that is sustained >12 months)
2. Left atrial diameter > 5.0 cm (anteroposterior)
3. Prior left atrial ablation or surgical procedure (including left atrial appendage closures)
4. Planned LAA closure procedure or implant of a permanent pacemaker, biventricular pacemaker, loop recorder/insertable cardiac monitor (ICM), or any type of implantable cardiac defibrillator (with or without biventricular pacing function) for any time during the follow-up period
5. Patient who is not on oral anticoagulation therapy for at least 3 weeks prior to the ablation procedure
6. Presence of a permanent pacemaker, biventricular pacemaker, loop recorder/insertable cardiac monitor (ICM), or any type of implantable cardiac defibrillator (with or without biventricular pacing function)
7. Presence of any pulmonary vein stents
8. Presence of any pre-existing pulmonary vein stenosis
9. Pre-existing hemidiaphragmatic paralysis
10. Presence of any cardiac valve prosthesis
11. Moderate to severe mitral valve stenosis
12. More than moderate mitral regurgitation (i.e., 3+ or 4+ MR)
13. Any cardiac surgery, myocardial infarction, PCI / PTCA or coronary artery stenting which occurred during the 3-month interval preceding the consent date
14. Unstable angina
15. NYHA Class III or IV congestive heart failure or documented left ventricular ejection fraction (LVEF) less than or equal to 35% measure by acceptable cardiac testing (e.g. TTE)
16. Primary pulmonary hypertension
17. Rheumatic heart disease
18. Thrombocytosis, thrombocytopenia
19. Any condition contraindicating chronic anticoagulation
20. Active systemic infection
21. Hypertrophic cardiomyopathy
22. Known reversible causes of AF, including but not limited to uncontrolled hyperthyroidism, severe untreated obstructive sleep apnea, and acute alcohol toxicity
23. Any cerebral ischemic event (strokes or TIAs) which occurred during the 6-month interval preceding the consent date
24. History of thromboembolic event within the past 6 months or evidence of intracardiac thrombus at the time of the procedure
25. Any woman known to be pregnant or breastfeeding, or any woman of childbearing potential who is not on a reliable form of birth regulation method or abstinence
26. Patient with life expectancy that makes it unlikely 12 months of follow-up will be completed
27. Current or anticipated participation in any other clinical trial of a drug, device or biologic during the duration of the study not pre-approved by Medtronic
28. Known allergies or hypersensitivities to adhesives
29. Unwilling or unable to comply fully with study procedures and follow-up
30. Unable to provide own informed consent
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Other
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Other design features
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Phase
NA
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
10/12/2019
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
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Actual
28/11/2022
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Sample size
Target
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Accrual to date
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Final
421
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Recruitment in Australia
Recruitment state(s)
NSW
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Recruitment hospital [1]
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John Hunter Hospital - New Lambton Heights
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Recruitment postcode(s) [1]
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- New Lambton Heights
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Recruitment outside Australia
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United States of America
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Alabama
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Colorado
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Austria
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Linz
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Brugge
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Neuilly-sur-Seine
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Aomori
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Nieuwegein
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Spain
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Madrid
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Funding & Sponsors
Primary sponsor type
Commercial sector/industry
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Name
Medtronic Cardiac Rhythm and Heart Failure
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Address
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Ethics approval
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Summary
Brief summary
The study is a prospective, multi-center, non-randomized, unblinded worldwide pre-market clinical study. The purpose of the study is to provide data demonstrating the safety and effectiveness of the PulseSelectâ„¢ PFA System for the treatment of atrial fibrillation (AF). The study will also provide first in human insights into clinical safety and device function of the PulseSelect PFA System for pulmonary vein isolation (PVI) as a treatment for AF. To this end, the clinical study has been designed into phases (Pilot and Pivotal), with each phase comprising a separate data set that will be analyzed and reported on per the below objectives.
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Trial website
https://clinicaltrials.gov/study/NCT04198701
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Trial related presentations / publications
Verma A, Haines DE, Boersma LV, Sood N, Natale A, Marchlinski FE, Calkins H, Sanders P, Packer DL, Kuck KH, Hindricks G, Onal B, Cerkvenik J, Tada H, DeLurgio DB; PULSED AF Investigators. Pulsed Field Ablation for the Treatment of Atrial Fibrillation: PULSED AF Pivotal Trial. Circulation. 2023 May 9;147(19):1422-1432. doi: 10.1161/CIRCULATIONAHA.123.063988. Epub 2023 Mar 6. Verma A, Boersma L, Haines DE, Natale A, Marchlinski FE, Sanders P, Calkins H, Packer DL, Hummel J, Onal B, Rosen S, Kuck KH, Hindricks G, Wilsmore B. First-in-Human Experience and Acute Procedural Outcomes Using a Novel Pulsed Field Ablation System: The PULSED AF Pilot Trial. Circ Arrhythm Electrophysiol. 2022 Jan;15(1):e010168. doi: 10.1161/CIRCEP.121.010168. Epub 2021 Dec 29.
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Public notes
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Contacts
Principal investigator
Name
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Atul Verma, MD
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Address
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McGill University Health Centre/Research Institute of the McGill University Health Centre
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Contact person for scientific queries
No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Type
Other Details
Attachment
Study protocol
Study Protocol and Statistical Analysis Plan: vers...
[
More Details
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https://cdn.clinicaltrials.gov/large-docs/01/NCT04198701/Prot_SAP_000.pdf
Statistical analysis plan
Study Protocol and Statistical Analysis Plan: vers...
[
More Details
]
https://cdn.clinicaltrials.gov/large-docs/01/NCT04198701/Prot_SAP_000.pdf
Study protocol
Study Protocol and Statistical Analysis Plan: vers...
[
More Details
]
https://cdn.clinicaltrials.gov/large-docs/01/NCT04198701/Prot_SAP_001.pdf
Statistical analysis plan
Study Protocol and Statistical Analysis Plan: vers...
[
More Details
]
https://cdn.clinicaltrials.gov/large-docs/01/NCT04198701/Prot_SAP_001.pdf
Study protocol
Study Protocol and Statistical Analysis Plan: vers...
[
More Details
]
https://cdn.clinicaltrials.gov/large-docs/01/NCT04198701/Prot_SAP_002.pdf
Statistical analysis plan
Study Protocol and Statistical Analysis Plan: vers...
[
More Details
]
https://cdn.clinicaltrials.gov/large-docs/01/NCT04198701/Prot_SAP_002.pdf
Study protocol
Study Protocol and Statistical Analysis Plan: vers...
[
More Details
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https://cdn.clinicaltrials.gov/large-docs/01/NCT04198701/Prot_SAP_003.pdf
Statistical analysis plan
Study Protocol and Statistical Analysis Plan: vers...
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More Details
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https://cdn.clinicaltrials.gov/large-docs/01/NCT04198701/Prot_SAP_003.pdf
Results publications and other study-related documents
Type
Citations or Other Details
Journal
Verma A, Haines DE, Boersma LV, Sood N, Natale A, ...
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Journal
Verma A, Boersma L, Haines DE, Natale A, Marchlins...
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Results not provided in
https://clinicaltrials.gov/study/NCT04198701
Download to PDF