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Cryoballoon Pulmonary Vein Isolation vs. Radiofrequency Pulmonary Vein Isolation With Additional Right Atrial Linear Ablation for Valvular Atrial Fibrillation: Prospective Randomized Trial (CRAVA Trial)

Primary Purpose

Valvular Atrial Fibrillation

Status
Not yet recruiting
Phase
Not Applicable
Locations
Korea, Republic of
Study Type
Interventional
Intervention
Cryoballoon Pulmonary Vein isolation
Radiofrequency Pulmonary Vein isolation and Additional Right Atrial linear ablation
Sponsored by
Yonsei University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Valvular Atrial Fibrillation focused on measuring Valvular Atrial fibrillation, Radiofrequency Pulmonary vein isolation, Cryoballoon Pulmonary Vein isolation

Eligibility Criteria

20 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • 1. Patient with hemodynamic corrected valvular atrial fibrillation who is scheduled for ablation procedure and ≥20 and ≤80 years of age
  • 2. Left atrium size < 50mm
  • 3. paroxysmal atrial fibrillation that is recurrence during antiarrhythmic drug treatment or is not able to use an antiarrhythmic drug.
  • 4. Patient who is indicated for anticoagulation therapy (for prevention of cerebral infarction)

Exclusion Criteria:

  • 1. Patients with permanent atrial fibrillation
  • 2. Atrial fibrillation associated with severe cardiac malformation or a structural heart disease that is hemodynamically affected
  • 3. Patients with severe renal impairment or CT imaging difficulty using contrast media
  • 4. Patients with a past history of radiofrequency ablation for atrial fibrillation or other cardiac surgery
  • 5. Patients with active internal bleeding
  • 6. Patients with contraindications for anticoagulation therapy(for prevention of cerebral infarction) and antiarrhythmic drugs
  • 7. Patients with non-valvular atrial fibrillation
  • 8. Patients with a severe comorbid disease
  • 9. Expected survival < 1 year
  • 10. Drug addicts or alcoholics
  • 11. Patients who cannot read the consent form (illiterates, foreigners, etc.)
  • 12. Other patients who are judged by the principal or sub-investigator to be ineligible for participation in this clinical study

Sites / Locations

  • Severance Cardiovascular Hospital, Yonsei University Health System

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Cryoballoon Pulmonary Vein isolation

Radiofrequency Pulmonary Vein isolation

Arm Description

Pulmonary vein isolation will be performed using a cryoballoon catheter. Esophageal temperature will be monitored to prevent esophageal injury. A 28mm second or third cryoballoon catheter will be used. Esophageal temperature will be monitored to prevent esophageal injury. Cryoablation will be performed for 180 secs at -45°C or below on condition that the pulmonary vein is occluded with a cryoballoon. CMAP (compound motor action potential) monitoring will be done to avoid phrenic nerve damage during the freezing of the right superior pulmonary vein. The procedure and cryoablation times will be evaluated. Rhythm follow-up will be performed after the procedure in accordance with the aforementioned study design.

Pulmonary vein isolation will be performed using a radiofrequency catheter. Additional left atrium posterior wall isolation, left atrium anterior wall linear ablation, cavo-tricuspid isthmus ablation, superior vena cava-right atrial septal ablation. If any other trigger came from beyond pulmonary vein is detected after the administration of isoproterenol, additional local radiofrequency ablation will be followed. Evaluated the procedure and radiofrequency ablation time. Rhythm follow-up will be performed after the procedure in accordance with the aforementioned study design.

Outcomes

Primary Outcome Measures

Safety evaluation: Procedure-related cardiac complication rate
including open cardiac surgery, cerebral infarction, pericardial effusion or cardiac tamponade, hematoma in the inguinal puncture site and vascular complications within 30 days post procedure
Efficacy evaluation: clinical recurrence rate
Defined as atrial fibrillation or atrial tachycardia > 30 sec after 3 months within 1 year; based on the 2012 ACC/AHA/HRS guidelines, 24-hour Holter ECG monitoring will be performed at 3 month and every 6 months, and ECG and monitoring with a Holter or an event recorder will be performed at any time if the patient complains of symptoms

Secondary Outcome Measures

Comparison of procedure time
Comparison of ablation time
Comparison of hospitalization period
Comparison of re-hospitalization rate after the procedure
Comparison of re-hospitalization rate after the procedure
Comparison of number of electrical cardioversion after the procedure
Comparison of number of electrical cardioversion after the procedure
Major cardiovascular event rate - death, myocardial infarction, coronary angioplasty, and re-hospitalization for arrhythmia and heart failure

Full Information

First Posted
April 14, 2019
Last Updated
April 16, 2019
Sponsor
Yonsei University
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1. Study Identification

Unique Protocol Identification Number
NCT03920891
Brief Title
Cryoballoon Pulmonary Vein Isolation vs. Radiofrequency Pulmonary Vein Isolation With Additional Right Atrial Linear Ablation for Valvular Atrial Fibrillation: Prospective Randomized Trial (CRAVA Trial)
Official Title
Cryoballoon Pulmonary Vein Isolation vs. Radiofrequency Pulmonary Vein Isolation With Additional Right Atrial Linear Ablation for Valvular Atrial Fibrillation: Prospective Randomized Trial (CRAVA Trial)
Study Type
Interventional

2. Study Status

Record Verification Date
April 2019
Overall Recruitment Status
Not yet recruiting
Study Start Date
May 2019 (Anticipated)
Primary Completion Date
March 2029 (Anticipated)
Study Completion Date
March 2029 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Yonsei University

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Cryoballoon ablation is proven to be effective in pulmonary vein isolation in patients with paroxysmal and persistent atrial fibrillation. We previously reported that the rhythm outcome of radiofrequency (RF) catheter ablations are equivalent in patients with non-valvular atrial fibrillation and in those with surgically and hemodynamically corrected valvular atrial fibrillation. In contrast, the Cryoballoon ablation can reduce the procedure times, it cannot conduct empirical linear ablation or extra-pulmonary vein foci ablation. The aim of this study is to compare Cryoballoon pulmonary vein isolation and RF ablation including linear ablation or extra-pulmonary vein foci ablations in patients with hemodynamically corrected valvular atrial fibrillation.
Detailed Description
A. Study design Prospective randomization (cryoballoon PV isolation group vs. Radiofrequency Pulmonary Vein isolation and Additional Right Atrial linear ablation) (Using the Python program, a random number module is imported with the import random syntax, and the random number table for the two groups is created.) Target number of subjects: 154 (77 per group) Rhythm FU : 2012 ACC/AHA/ESC guidelines (Holter monitoring at the baseline, 3,6 month, and thereafter every 6 months to 24 month, then every 1 year; ECG if the patient has any symptom) Anticoagulant therapy followed by 2014 ACC/AHA/ESC guidelines All complications in each group will be evaluated including the re-hospitalization rate, major cardiovascular event, and mortality rate. B. Progress and rhythm/ECG follow-up To be performed in accordance with the 2012 ACC/AHA/HRS guidelines for AF management Follow-up at 1 weeks, 3,6 months, and thereafter every 6-month after procedure. Rhythm control at 3, 6 months, and thereafter every 6 months for 2 years, and every year after 2 years follow-up with Holter If the patient complains of symptoms, ECG will be performed at any time, and rhythm follow-up will be carried out with a Holter or event recorder. C. Follow-up All the patients will be followed-up at 1 weeks, 3, 6 months, and thereafter every 6 months. If the patient shows any symptom within the clinical study period, patient will visit the outpatient clinic. ECG will be performed at every outpatient visits, and 24-hour Holter or event recording will be performed 3, 6 months, and thereafter every 6 months for 2 years, and every year after 2 years (2012 Heart Rhythm Society/EHRA/European Cardiac Arrhythmia Society Expert Consensus Statement guidelines). If atrial fibrillation or atrial tachycardia lasting more than 30 seconds is observed in 12-lead ECG or Holter, it will be evaluated as recurrence. Recurrence within 3 months after the procedure will be classified as early recurrence, and that after 3 months will be classified as clinical recurrence.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Valvular Atrial Fibrillation
Keywords
Valvular Atrial fibrillation, Radiofrequency Pulmonary vein isolation, Cryoballoon Pulmonary Vein isolation

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
154 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Cryoballoon Pulmonary Vein isolation
Arm Type
Experimental
Arm Description
Pulmonary vein isolation will be performed using a cryoballoon catheter. Esophageal temperature will be monitored to prevent esophageal injury. A 28mm second or third cryoballoon catheter will be used. Esophageal temperature will be monitored to prevent esophageal injury. Cryoablation will be performed for 180 secs at -45°C or below on condition that the pulmonary vein is occluded with a cryoballoon. CMAP (compound motor action potential) monitoring will be done to avoid phrenic nerve damage during the freezing of the right superior pulmonary vein. The procedure and cryoablation times will be evaluated. Rhythm follow-up will be performed after the procedure in accordance with the aforementioned study design.
Arm Title
Radiofrequency Pulmonary Vein isolation
Arm Type
Active Comparator
Arm Description
Pulmonary vein isolation will be performed using a radiofrequency catheter. Additional left atrium posterior wall isolation, left atrium anterior wall linear ablation, cavo-tricuspid isthmus ablation, superior vena cava-right atrial septal ablation. If any other trigger came from beyond pulmonary vein is detected after the administration of isoproterenol, additional local radiofrequency ablation will be followed. Evaluated the procedure and radiofrequency ablation time. Rhythm follow-up will be performed after the procedure in accordance with the aforementioned study design.
Intervention Type
Procedure
Intervention Name(s)
Cryoballoon Pulmonary Vein isolation
Intervention Description
Pulmonary vein isolation will be performed using a cryoballoon catheter. Esophageal temperature will be monitored to prevent esophageal injury. A 28mm second or third cryoballoon catheter will be used. Esophageal temperature will be monitored to prevent esophageal injury. Cryoablation will be performed for 180 secs at -45°C or below on condition that the pulmonary vein is occluded with a cryoballoon. CMAP (compound motor action potential) monitoring will be done to avoid phrenic nerve damage during the freezing of the right superior pulmonary vein. The procedure and cryoablation times will be evaluated. Rhythm follow-up will be performed after the procedure in accordance with the aforementioned study design.
Intervention Type
Procedure
Intervention Name(s)
Radiofrequency Pulmonary Vein isolation and Additional Right Atrial linear ablation
Intervention Description
Pulmonary vein isolation will be performed using a radiofrequency catheter. Additional left atrium posterior wall isolation, left atrium anterior wall linear ablation, cavo-tricuspid isthmus ablation, superior vena cava-right atrial septal ablation. If any other trigger came from beyond pulmonary vein is detected after the administration of isoproterenol, additional local radiofrequency ablation will be followed. Evaluated the procedure and radiofrequency ablation time. Rhythm follow-up will be performed after the procedure in accordance with the aforementioned study design.
Primary Outcome Measure Information:
Title
Safety evaluation: Procedure-related cardiac complication rate
Description
including open cardiac surgery, cerebral infarction, pericardial effusion or cardiac tamponade, hematoma in the inguinal puncture site and vascular complications within 30 days post procedure
Time Frame
within 30 days post procedure
Title
Efficacy evaluation: clinical recurrence rate
Description
Defined as atrial fibrillation or atrial tachycardia > 30 sec after 3 months within 1 year; based on the 2012 ACC/AHA/HRS guidelines, 24-hour Holter ECG monitoring will be performed at 3 month and every 6 months, and ECG and monitoring with a Holter or an event recorder will be performed at any time if the patient complains of symptoms
Time Frame
Within 1 year after 3 months of procedure
Secondary Outcome Measure Information:
Title
Comparison of procedure time
Time Frame
immediate after procedure
Title
Comparison of ablation time
Time Frame
immediate after procedure
Title
Comparison of hospitalization period
Time Frame
immediate after procedure
Title
Comparison of re-hospitalization rate after the procedure
Time Frame
immediate after procedure
Title
Comparison of re-hospitalization rate after the procedure
Time Frame
12 months after procedure
Title
Comparison of number of electrical cardioversion after the procedure
Time Frame
immediate after procedure
Title
Comparison of number of electrical cardioversion after the procedure
Time Frame
12 months after procedure
Title
Major cardiovascular event rate - death, myocardial infarction, coronary angioplasty, and re-hospitalization for arrhythmia and heart failure
Time Frame
immediate after procedure and 12 months after procedure

10. Eligibility

Sex
All
Minimum Age & Unit of Time
20 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: 1. Patient with hemodynamic corrected valvular atrial fibrillation who is scheduled for ablation procedure and ≥20 and ≤80 years of age 2. Left atrium size < 50mm 3. paroxysmal atrial fibrillation that is recurrence during antiarrhythmic drug treatment or is not able to use an antiarrhythmic drug. 4. Patient who is indicated for anticoagulation therapy (for prevention of cerebral infarction) Exclusion Criteria: 1. Patients with permanent atrial fibrillation 2. Atrial fibrillation associated with severe cardiac malformation or a structural heart disease that is hemodynamically affected 3. Patients with severe renal impairment or CT imaging difficulty using contrast media 4. Patients with a past history of radiofrequency ablation for atrial fibrillation or other cardiac surgery 5. Patients with active internal bleeding 6. Patients with contraindications for anticoagulation therapy(for prevention of cerebral infarction) and antiarrhythmic drugs 7. Patients with non-valvular atrial fibrillation 8. Patients with a severe comorbid disease 9. Expected survival < 1 year 10. Drug addicts or alcoholics 11. Patients who cannot read the consent form (illiterates, foreigners, etc.) 12. Other patients who are judged by the principal or sub-investigator to be ineligible for participation in this clinical study
Facility Information:
Facility Name
Severance Cardiovascular Hospital, Yonsei University Health System
City
Seoul
ZIP/Postal Code
120-752
Country
Korea, Republic of

12. IPD Sharing Statement

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Cryoballoon Pulmonary Vein Isolation vs. Radiofrequency Pulmonary Vein Isolation With Additional Right Atrial Linear Ablation for Valvular Atrial Fibrillation: Prospective Randomized Trial (CRAVA Trial)

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