Clinical trial NCT01683045: Efficacy and Safety Study of the Estech COBRA® Surgical System to Treat Patients With a History of Irregular Heart Beats
Official title: Ablation for the Treatment of Concomitant Atrial Fibrillation in Non-Paroxysmal Patients (ATTAC-AF)
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: NA
Conditions: Persistent Atrial Fibrillation
Keywords: non-paroxysmal atrial fibrillation
persistent atrial fibrillation
atrial fibrillation
heart palpitations
irregular heart beat
temperature-controlled radiofrequency ablation
radiofrequency energy
TCRF energy
RF energy
epicardial and endocardial lesions
concomitant heart surgery
surgical ablation
Lead sponsor: Endoscopic Technologies, Inc
Sponsor class: INDUSTRY
First posted: 2012-09-11
Enrollment: 6
Sex: ALL
Minimum age (years): 18
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: The purpose of this study is to demonstrate that the Estech COBRA Surgical System is an effective treatment for patients with irregular heart beats who are undergoing heart surgery.

Detailed description: The objective of the trial is to demonstrate that the creation of epicardial and endocardial lesions with temperature-controlled radiofrequency (TCRF) ablation applied using the Estech COBRA® Surgical System during concomitant heart surgery is a safe and effective treatment for non-paroxysmal atrial fibrillation (AF).

Eligibility criteria: Inclusion Criteria:

All subjects are required to meet the following inclusion criteria in order to be considered eligible for participation in this trial:

1. Subject is scheduled to undergo elective on-pump cardiac surgical procedure(s) for one or more of the following:

   1. Mitral valve repair or replacement,
   2. Aortic valve repair or replacement,
   3. Tricuspid valve repair or replacement, or
   4. Coronary Artery Bypass procedures;
2. Subject has history of a non-paroxysmal form of AF for greater than 3 months and has failed at least one attempt at electrical cardioversion or had a successful attempt at electrical cardioversion but had a recurrence of AF within 30 days of the cardioversion;
3. Age 18 to 80 years old;
4. Left ventricular ejection fraction (LVEF) ≥ 30%;
5. Subject has no contraindications to intraoperative transesophageal echocardiography;
6. Subject has a life expectancy greater than 12 months; and
7. Willing and capable of providing Informed Consent to undergo surgery and participate in all examinations and follow-ups associated with this clinical trial.

A subject is considered to have failed electrical cardioversion if they did not achieve sinus rhythm for at least 30 seconds following the attempted cardioversion.

Exclusion Criteria:

Subjects will be excluded from participating in this trial if they meet any of the following exclusion criteria:

1. History of non-paroxysmal AF less than 3 months or for more than 5 years;
2. History of prior cardiac ablative surgical or catheter-based therapy;
3. Previous cardiac surgery (redo) or other intrapericardial procedures;
4. Class IV NYHA heart failure;
5. Known carotid artery stenosis greater than 80% or previous carotid endarterectomy;
6. Wolff-Parkinson-White syndrome;
7. Need for emergent cardiac surgery (e.g., cardiogenic shock);
8. Untreated hyperthyroidism;
9. Untreated hypothyroidism;
10. Acute pulmonary disease;
11. Electrolyte imbalance;
12. History of myocarditis;
13. Presence of a previously implanted device in or adjacent to the treatment target area that may alter the delivery of therapy (e.g., valvular prosthesis or ring, pacemaker with leads in coronary sinus or internal defibrillator leads);
14. History of pericarditis;
15. Previous left phrenic nerve paralysis;
16. Bullous lung disease;
17. Presence of active endocarditis, or local or systemic infection;
18. Recent myocardial infarction (\< 3 months);
19. Renal failure requiring dialysis or hepatic failure or creatinine of \>2 mg/dL preoperatively;
20. Antiarrhythmic drug therapy required for the treatment of a ventricular arrhythmia;
21. Preoperative need for an intra-aortic balloon pump or intravenous inotropes;
22. Severe peripheral arterial occlusive disease defined as claudication with minimal exertion;
23. Therapy resulting in compromised tissue integrity including: thoracic radiation, chemotherapy, long term treatment with oral or injected steroids, or known connective tissue disorders;
24. Documented left atrial size of 6 cm or more;
25. History of cerebrovascular disease or accident, including stroke or transient ischemic attack (TIA) within 6 months prior to enrollment;
26. Known contraindication to anticoagulant therapy or inability to comply with anticoagulant therapy;
27. Pregnancy, planned pregnancy (females of childbearing potential must have a negative pregnancy test prior to enrollment and agree not to become pregnant during the trial) or breastfeeding;
28. Forced expiratory volume in 1 second less than 30% of predicted value or need for home oxygen therapy; or
29. Surgical management of hypertrophic obstructive cardiomyopathy.

Primary outcomes:
measure: Primary Efficacy Endpoint
timeFrame: The primary efficacy endpoint will be assessed following the blanking interval through Month 12.
measure: Primary Safety Endpoint
timeFrame: The primary safety endpoint will be assessed within 30 days of the procedure or hospital discharge, whichever is later.
Secondary outcomes:
measure: Secondary Efficacy Endpoint
timeFrame: The secondary efficacy endpoints will be assessed following the procedure through the 12 month follow-up visit.
measure: Secondary Safety Endpoint
timeFrame: The secondary safety endpoints will be assessed up to 3 years post procedure.
Other outcomes:
Locations:
city: Mesa
country: United States
facility: Banner Good Samaritan Medical Center
state: Arizona
city: Hartford
country: United States
facility: Hartford Hospital
state: Connecticut
city: Atlanta
country: United States
facility: Saint Joseph's Hospital of Atlanta
state: Georgia
city: Evanston
country: United States
facility: North Shore Univ. Health System
state: Illinois
city: Oak Lawn
country: United States
facility: Advocate Christ Medical Center
state: Illinois
city: Kansas City
country: United States
facility: The Univ. of Kansas Hospital
state: Kansas
city: Ann Arbor
country: United States
facility: Univ. of Michigan Cardiovascular Center
state: Michigan
city: Rochester
country: United States
facility: Mayo Clinic / St. Mary's Hospital
state: Minnesota
city: New York
country: United States
facility: Lenox Hill Hospital / North Shore-LIJ Health System
state: New York
city: Utica
country: United States
facility: Mohawk Valley Heart Institute / St. Elizabeth Medical Center
state: New York
city: Columbia
country: United States
facility: Sisters of Charity, Providence Hospital
state: South Carolina
city: Falls Church
country: United States
facility: Fairfax Hospital, Department of Cardiovascular and Thoracic Surgery
state: Virginia
city: Milwaukee
country: United States
facility: Aurora St. Luke's Medical Center
state: Wisconsin
Study officials:
affiliation: Endoscopic Technologies, Inc
name: David K Swanson, Ph.D.
role: PRINCIPAL_INVESTIGATOR
References: