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FIRE AND ICE: Comparative Study of Two Ablation Procedures in Patients With Atrial Fibrillation

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
ClinicalTrials.gov Identifier: NCT01490814
Recruitment Status : Completed
First Posted : December 13, 2011
Results First Posted : November 2, 2018
Last Update Posted : November 2, 2018
Information provided by (Responsible Party):
Medtronic Atrial Fibrillation Solutions

Brief Summary:
Comparing efficacy and safety of isolation of the pulmonary veins (PV) using a Cryoballoon catheter versus a radiofrequency ablation with a ThermoCool catheter in patients with paroxysmal atrial fibrillation.

Condition or disease Intervention/treatment Phase
Symptomatic Paroxysmal Atrial Fibrillation (PAF) Procedure: Electrical isolation of the pulmonary veins Procedure: Electrical isolation of pulmonary veins Not Applicable

Detailed Description:
The purpose of this randomized clinical trial is to compare the efficacy and safety of isolating the PVs with either the cryoballoon or a RF ablation technique with a ThermoCool catheter, a system which can be regarded as standard for ablation. In total 762 patients with paroxysmal atrial fibrillation has been randomized for either radiofrequency (RF) or cryoballoon. With both techniques, PV isolation will be performed. Primary end point of the trial is the time to first recurrence of atrial arrhythmias or prescription of anti-arrhythmic drugs after a blanking period of three months. Treatment success will be evaluated by using weekly electrocardiography (ECG) monitoring (transtelephonic transmission/Tele-ECG) and using Holter electrocardiograms.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 769 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Controlled, Prospective, Non-Inferiority, Parallel-Group, Randomised, Interventional, Open, Blinded Outcome Assessment (PROBE-Design), Multi-centre Trial, Comparing Efficacy and Safety of Isolation of the PVs With a Cryoballoon Catheter vs a Radiofrequency Ablation With a ThermoCool Catheter in Patients With PAF
Study Start Date : December 2011
Actual Primary Completion Date : January 2016
Actual Study Completion Date : January 2016

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Active Comparator: Cryoballoon ablation Procedure: Electrical isolation of the pulmonary veins
Device: ArcticFront® Cardiac CryoAblation Catheter System with the FlexCath Steerable Sheath or ArcticFront® Advance Cardiac CryoAblation Catheter System with the FlexCath Steerable Sheath or any future development generations of this product line, provided they are CE marked and the centre has the experience of at least 10 procedures before including a patient into the study.

Active Comparator: Radiofrequency ablation Procedure: Electrical isolation of pulmonary veins
Device:NaviStar® ThermoCool® Irrigated Tip Ablation Catheter in combination with 3D mapping system CARTO or any future development generations of this product line, provided they are CE marked and the centre has the experience of at least 10 procedures before including a patient into the study.

Primary Outcome Measures :
  1. Number of Subjects With Recurrence of Atrial Arrhythmias or Prescription of Anti-arrhythmic Drug or Re-ablation After a Blanking Period of Three Months After the Initial Ablation Procedure [ Time Frame: 33 months ]
    Number of subjects reporting a primary efficacy endpoint

  2. Number of Subjects With a Primary Safety Event. A Primary Safety Event Includes a Composite of Death (Including Cardiovascular Death), All-cause Stroke/Transient Ischemic Attack (TIA) and Serious Adverse Events of Special Interest. [ Time Frame: 33 months ]

Secondary Outcome Measures :
  1. All-cause Death [ Time Frame: 33 months ]
  2. Arrhythmia-related Death [ Time Frame: 33 months ]
  3. Total Procedure Duration [ Time Frame: Through the initial ablation procedure ]
  4. Total Time of Fluoroscopy [ Time Frame: Fluoroscopy meter time through the initial ablation procedure ]
  5. Number of Subjects Reporting a Cardiovascular Hospitalization Over the Duration of the Study. [ Time Frame: 33 months ]
  6. Number of Cardiovascular Hospitalizations [ Time Frame: 33 months ]
    The total number of cardiovascular hospitalizations reported over the duration of the study.

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Symptomatic PAF with at least two episodes and at least one episode documented (30 seconds episode length, documented by ECG within last 12 months).
  • Documented treatment failure for effectiveness of at least one anti-arrhythmic drug(AAD Type I or III, including β-blocker and AAD intolerance).
  • ≥ 18 and ≤ 75 years of age.
  • Patients who are mentally and linguistically able to understand the aim of the trial and to show sufficient compliance in following the trial protocol.
  • Patient is able to verbally acknowledge and understand the associated risks, benefits, and treatment alternatives to therapeutic options of this trial: cryoballoon ablation system or standard RF ablation technique. The patients, by providing informed consent, agree to these risks and benefits as stated in the patient informed consent document. All the details have been presented to him and he has signed the informed consent form for the trial.

Exclusion Criteria:

General exclusion criteria

  • Any disease that limits life expectancy to less than one year.
  • Participation in another clinical trial (of a drug, device or biologic), either within the past two months or ongoing.
  • Pregnant women or women of childbearing potential not on adequate birth control: only women with a highly effective method of contraception [oral contraception or intrauterine device (IUD)] or sterile women can be randomized.
  • Breastfeeding women.
  • Substance misuse.
  • Active systemic infection.
  • Cryoglobulinaemia.
  • Previous participation in this clinical trial.
  • Employment by the sponsor or by the department of any of the investigators.
  • Close relatives of any of the investigators.

Exclusion criteria related to a cardiac condition

  • Patients with prosthetic valves.
  • Any previous LA ablation or surgery.
  • Any cardiac surgery or percutaneous coronary intervention (PCI) within three months prior to enrollment.
  • Unstable angina pectoris.
  • Myocardial infarction within three months prior to enrollment.
  • Symptomatic carotid stenosis.
  • Chronic obstructive pulmonary disease with detected pulmonary hypertension.
  • Any condition contraindicating chronic anticoagulation.
  • Stroke or transient ischemic attack within six months prior to enrollment.
  • Any significant congenital heart defect corrected or not (including atrial septal defects or PV abnormalities) but not including patent foramen ovale.
  • New York Heart Association (NYHA) class III or IV congestive heart failure.
  • EF < 35 % (determined by echocardiography within 60 days of enrollment as documented in patient medical history).
  • Anteroposterior LA diameter > 55 mm (by trans-thoracic echocardiography (TTE or TEE) within three months to prior enrollment).
  • LA thrombus (TEE diagnostic performed on admission).
  • Intracardiac thrombus.
  • PV diameter > 26 mm in right sided PVs.
  • Mitral prosthesis.
  • Hypertrophic cardiomyopathy (see Appendix IX)
  • 2° (Type II) or 3° atrioventricular block.
  • Brugada syndrome or long QT syndrome.
  • Arrhythmogenic right ventricular dysplasia.
  • Sarcoidosis.
  • PV stent.
  • Myxoma.

Exclusion criteria based on laboratory abnormalities

  • Thrombocytosis (platelet count > 600,000 / µl), thrombocytopenia (platelet count < 100,000 / µl).
  • Any untreated or uncontrolled hyperthyroidism or hypothyroidism.
  • Severe renal dysfunction (stage V, requiring or almost requiring dialysis, glomerular filtration rate (GFR) < 15 ml / min).

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01490814

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Sponsors and Collaborators
Medtronic Atrial Fibrillation Solutions
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Principal Investigator: Karl-Heinz Kuck, Prof. Dr. Asklepios Klinikum St. Georg
Additional Information:
Publications of Results:
Other Publications:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

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Responsible Party: Medtronic Atrial Fibrillation Solutions
ClinicalTrials.gov Identifier: NCT01490814    
Other Study ID Numbers: FI-123
First Posted: December 13, 2011    Key Record Dates
Results First Posted: November 2, 2018
Last Update Posted: November 2, 2018
Last Verified: March 2018
Keywords provided by Medtronic Atrial Fibrillation Solutions:
two episodes within the last twelve months one episode documented
Documented treatment failure of at least one antiarrhythmic
drug AAD Type I or III including β-blocker and AAD intolerance
Additional relevant MeSH terms:
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Atrial Fibrillation
Arrhythmias, Cardiac
Heart Diseases
Cardiovascular Diseases
Pathologic Processes