investigational device exemption (ide) study for the approval of closed loop stimulation (cls) and cardiac resyncronization pacing therapies (crt) for the treatment of atrial fibrillation (af) with ablate and pace

Conditions: Atrial Fibrillation; Congestive Heart Failure

Summary: the purpose of this study is to demonstrate the safety and effectiveness of biventricular pacing over conventional right ventricular pacing in patients with persistent or permanent, symptomatic atrial fibrillation undergoing atrioventricular (av) node ablation and permanent pacing therapy.

this study is a multi-center, prospective, randomized, blinded trial. the study will consist of approximately 265 patients who require treatment of persistent or permanent, symptomatic atrial fibrillation by atrioventricular (av) node ablation and permanent pacing therapy i.e. "ablate and pace" therapy. all patients enrolled into the clinical study will be randomly assigned to one of three groups using a randomization ratio of 2:2:1. patients will be assigned to receive either biventricular (biv) pacing with cls-based rate adaptive pacing using the legally marketed protos dr/cls (group 1), or biventricular pacing with accelerometer-based rate adaptive pacing using the stratos lv (group 2), or right ventricular (rv) pacing with accelerometer-based rate adaptive pacing using the stratos lv (group 3). patients in all three groups will be implanted with legally marketed right and left ventricular pacing leads. the patients, the core lab used to interpret the echocardiographic data and the clinical events committee adjudicating crossover, patient death and congestive heart failure (chf) hospitalizations will be blinded to the randomization assignment.

Eligibility criteria:
inclusion criteria: * meet the indications for therapy * persistent, symptomatic af with poorly controlled rapid ventricular rates or permanent, symptomatic af with poorly controlled rapid ventricular rates. * eligible for av nodal ablation and permanent pacemaker implantation * nyha class ii or iii heart failure * age ≥ 18 years * understand the nature of the procedure * ability to tolerate the surgical procedure required for implantation * give informed consent * able to complete all testing required by the clinical protocol * available for follow-up visits on a regular basis at the investigational site exclusion criteria: * meet one or more of the contraindications * have a life expectancy of less than six months * expected to receive heart transplantation within six months * enrolled in another cardiovascular or pharmacological clinical investigation * patients with an icd, or being considered for an icd * patients with previously implanted biventricular pacing systems * patients with previously implanted single or dual chamber pacing system with \> 50% documented ventricular pacing * patients with previous av node ablation * six-minute walk test distance greater than 450 meters * any condition preventing the patient from being able to perform required testing * presence of another life-threatening, underlying illness separate from their cardiac disorder * conditions that prohibit placement of any of the lead systems

Keywords: atrial fibrillation av node ablation pacemaker congestive heart failure