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Multi-electrode Radiofrequency Balloon Catheter Use for the Isolation of the Pulmonary Veins. (SHINE)

Primary Purpose

Paroxysmal Atrial Fibrillation

Status
Completed
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
Radiofrequency Ablation
Sponsored by
Biosense Webster, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Paroxysmal Atrial Fibrillation focused on measuring Radiofrequency Ablation, Paroxysmal Atrial Fibrillation

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Diagnosed with Symptomatic Paroxysmal AF.
  2. Selected for atrial fibrillation (AF) ablation procedure for pulmonary vein isolation.
  3. Able and willing to comply with uninterrupted per-protocol anticoagulation requirements
  4. Age 18-75 years.
  5. Able and willing to comply with all pre-, post- and follow-up testing and requirements.
  6. Signed Patient Informed Consent Form.

Exclusion Criteria:

  1. AF secondary to electrolyte imbalance, thyroid disease, or reversible or non-cardiac cause.
  2. Previous surgical or catheter ablation for AF.
  3. Anticipated to receive ablation outside the PV ostia and Cavo-triscuspid-isthmus (CTI) region
  4. Previously diagnosed with persistent, longstanding AF and/or continuous AF > 7 days, or > 48 hrs terminated by cardioversion.
  5. Any percutaneous coronary intervention (PCI) within the past 2 months.
  6. Valve repair or replacement and presence of a prosthetic valve.
  7. Any carotid stenting or endarterectomy.
  8. Coronary artery bypass grafting (CABG), cardiac surgery (e.g. ventriculotomy, atriotomy), or valvular cardiac surgical or percutaneous procedure within the past 6 months.
  9. Documented left atrium (LA) thrombus on baseline/pre-procedure imaging.
  10. LA antero posterior diameter > 50 mm
  11. Any PV with a diameter ≥ 26 mm
  12. Left Ventricular Ejection Fraction (LVEF) < 40%.
  13. Contraindication to anticoagulation (e.g. heparin).
  14. History of blood clotting or bleeding abnormalities.
  15. Myocardial infarction within the past 2 months.
  16. Documented thromboembolic event [including transient ischemic attack(TIA)] within the past 12 months.
  17. Rheumatic Heart Disease.
  18. Uncontrolled heart failure or New York Heart Association (NYHA) function class III or IV.
  19. Awaiting cardiac transplantation or other cardiac surgery within the next 12 months.
  20. Unstable angina.
  21. Acute illness or active systemic infection or sepsis.
  22. Diagnosed atrial myxoma or interatrial baffle or patch.
  23. Presence of implanted pacemaker or implantable cardioverter defibrillator (ICD).
  24. Significant pulmonary disease, (e.g. restrictive pulmonary disease, constrictive or chronic obstructive pulmonary disease) or any other disease or malfunction of the lungs or respiratory system that produces chronic symptoms.
  25. Significant congenital anomaly or medical problem that, in the opinion of the investigator, would preclude enrollment in this study.
  26. Women who are pregnant (as evidenced by pregnancy test if pre-menopausal), lactating, or who are of child bearing age and plan on becoming pregnant during the course of the clinical investigation.
  27. Enrollment in an investigational study evaluating another device, biologic, or drug.
  28. Has known pulmonary vein stenosis.
  29. Presence of intramural thrombus, tumor or other abnormality that precludes vascular access, or manipulation of the catheter.
  30. Presence of an Inferior Vena Cava (IVC) filter
  31. Presence of a condition that precludes vascular access.
  32. Life expectancy or other disease processes likely to limit survival to less than 12 months.
  33. Presenting contra-indication for the devices (e.g. transthoracic echocardiography (TTE), CT, etc.) used in the study, as indicated in the respective instructions for use.
  34. Categorized as a vulnerable population and requires special treatment with respect to safeguards of well-being

    Additional exclusion criteria for Neurological Assessment Evaluable (NAE) subjects:

  35. Contraindication to use of contrast agents for MRI such as advanced renal disease, etc. (at PI discretion)
  36. Presence of iron-containing metal fragments in the body
  37. Unresolved pre-existing neurological deficit.

Sites / Locations

  • Na Homolce Hospital
  • Ospedale "F. Miulli"
  • Centro Cardiologico Monzino
  • Liverpool Heart and Chest Hospital
  • Bart's Health NHS Trust

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Intervention

Arm Description

Ablation with Multi-electrode Radiofrequency (RF) Balloon Catheter

Outcomes

Primary Outcome Measures

Number of Participants With Early Onset Primary Adverse Events (PAEs): Death, Atrio-esophageal Fistula and Pulmonary Vein Stenosis
A Primary AEs is an event which occurred within 90 days following initial ablation procedure. Primary AEs included: Death, atrio-esophageal fistula, and pulmonary vein stenosis.
Number of Participants With Early Onset PAEs: Myocardial Infraction, Cardiac Tamponade/Perforation, Thromboembolism, Stroke/Cerebrovascular Accident, Transient Ischemic Attack, Phrenic Nerve Paralysis, and Major Vascular Access Complication/Bleeding
A Primary AEs is an event which occurred within the first week (7 days of the initial mapping and ablation procedure) which included myocardial infraction (MI), cardiac tamponade (CT)/perforation, thromboembolism, stroke/cerebrovascular accident (CVA), Transient ischemic attack (TIA), phrenic nerve paralysis (PNP), and major vascular access complication (MVAC)/bleeding following initial ablation procedure.
Percentage of Participants With Acute Procedural Success
Acute procedural success is defined as confirmation of entrance block in treated pulmonary veins (PV) after adenosine and/or isoproterenol challenge (with or without the use of a focal catheter).

Secondary Outcome Measures

Number of Participants With Individual PAE From Primary Composite
A Primary AEs is an event which occurred within the first week (7 days of the initial mapping and ablation procedure) which included death, atrio-esophageal fistula (AE fistula) and pulmonary vein stenosis (PVST); and up to 90 days post procedure which included myocardial infraction (MI), cardiac tamponade (CT)/perforation, thromboembolism, stroke/cerebrovascular accident (CVA), Transient ischemic attack (TIA), phrenic nerve paralysis (PNP), and major vascular access complication (MVAC)/bleeding following initial ablation procedure.
Number of Participants With Serious Adverse Device Effects (SADEs)
An adverse device effect is an adverse event related to the to the device and or the procedure of the investigational medical device. SADE is an adverse device effect that has resulted in any of the consequences characteristic of an SAE.
Number of Participants With Serious Non-primary Adverse Events Within 7 Days (Early Onset), 8-30 Days (Peri-procedural) and Greater Than or Equal to (>=) 31 Days (Late Onset) of Initial Ablation Procedure
Serious non-primary adverse event was defined as SAE that are not primary adverse events. Primary AEs included: Death, atrio-esophageal fistula, and pulmonary vein stenosis.
Number of Participants With Non-serious Adverse Events
An AE is any untoward medical occurrence in participants whether or not related to the investigational medical device.
Number of Participants With Pre-and Post-ablation Asymptomatic and Symptomatic Cerebral Emboli
Number of participants with pre-and post-ablation asymptomatic and symptomatic cerebral emboli was reported.
Number of Participants With Symptomatic and Asymptomatic Cerebral Emboli
Number of participants with symptomatic and asymptomatic cerebral emboli was reported
Number of Participants With New or Worsening Neurologic Deficits
Number of participants with new or worsening neurologic deficits was reported.
Number of Participants With NIHSS Scores
The National Institutes of Health Stroke Scale, or NIH Stroke Scale (NIHSS) is a tool used to objectively quantify the impairment caused by a stroke. The NIHSS is composed of 11 items, each of which scores a specific ability between 0 and 4. For each item, a score of 0 typically indicates normal function in that specific ability, while a higher score is indicative of some level of impairment. The individual scores from each item are summed to calculate a patient's total NIHSS score. The patient's total NIHSS score ranges from 0 (minimum) - 42 (maximum). Score 0 (no stroke symptoms); 1 - 4 (Minor stroke); 5-15 (Moderate stroke); 16-20 (Moderate to severe stroke); and 21-42 (Severe stroke).
Number of Participants With MoCA Scores
Montreal Cognitive Assessment (MoCA) is used for detecting cognitive impairment, the scores range from 0 to 30. A score of 26 or higher is considered normal, patients with mild cognitive impairment (MCI) were scored an average of 22 and patients with significant cognitive impairment (SCI) were scored an average of 16.
Number of Participants With Hospitalization for Cardiovascular Events
Hospitalization was defined as prolonged stay greater than or equal to (>=) 2 nights post index procedure or in-patient stay not concurrent with index procedure >= 1 calendar day. Hospitalization included cardiovascular events due to any cause post index procedure, regardless of protocol-defined serious/non-serious adverse events (AEs) or not. Hence this data was not contributed in serious Adverse events until met the AE definition.
Percentage of Participants With PVI Touch-up by Balloon and/or Focal Catheter Among All Targeted Veins and by Participants
Percentage of participants with PVI touch-up by balloon and/or focal catheter among all targeted veins and by participants was reported. Most of the participants were ablated by Balloon catheter only while one participant was ablated with both Balloon and Focal catheters.
Percentage of Participants With Use of Focal Catheter Ablation for Non-PV Triggers
Percentage of participants with use of focal catheter ablation for non-PV triggers was reported.
Percentage of Participants With Freedom From Documented Atrial Fibrillation (AF), Atrial Tachycardia (AT), or Atypical (Left Side) Atrial Flutter (AFL) Episodes or Documented Symptomatic AF/AT/AFL
Percentage of participants with six-month arrythmia recurrence [defined as freedom from documented symptomatic or asymptomatic atrial fibrillation (AF), atrial tachycardia (AT), or atypical (left side) atrial flutter (AFL) episodes (episodes >30 seconds on arrhythmia monitoring device from Day 91 to 180 post the index procedure)] was reported.
Percentage of Participants With Freedom From Documented, AF, AT, or Atypical (Left Side) AFL Episodes or Documented Symptomatic AF/AT/AFL
Twelve-month Arrythmia recurrence is defined as a documented symptomatic or asymptomatic episode >30 seconds on an arrhythmia monitoring device between day 91 to 365 post the index procedure.

Full Information

First Posted
February 13, 2018
Last Updated
December 1, 2020
Sponsor
Biosense Webster, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT03437733
Brief Title
Multi-electrode Radiofrequency Balloon Catheter Use for the Isolation of the Pulmonary Veins.
Acronym
SHINE
Official Title
Multi-electrode Radiofrequency Balloon Catheter Use for the Isolation of the Pulmonary Veins.
Study Type
Interventional

2. Study Status

Record Verification Date
November 2020
Overall Recruitment Status
Completed
Study Start Date
February 28, 2018 (Actual)
Primary Completion Date
February 1, 2019 (Actual)
Study Completion Date
October 17, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Biosense Webster, Inc.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Device Product Not Approved or Cleared by U.S. FDA
Yes
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This clinical investigation is a prospective, multicenter, single arm clinical evaluation utilizing the multi-electrode radiofrequency balloon catheter and the multi-electrode circular diagnostic catheter.
Detailed Description
The objective of this clinical investigation is to assess the safety and acute effectiveness of the multi-electrode radiofrequency balloon catheter and multi-electrode circular diagnostic catheter when used for the isolation of the pulmonary veins in the treatment of Paroxysmal Atrial Fibrillation (PAF).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Paroxysmal Atrial Fibrillation
Keywords
Radiofrequency Ablation, Paroxysmal Atrial Fibrillation

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
98 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Intervention
Arm Type
Experimental
Arm Description
Ablation with Multi-electrode Radiofrequency (RF) Balloon Catheter
Intervention Type
Device
Intervention Name(s)
Radiofrequency Ablation
Intervention Description
RF ablation using multi-electrode radiofrequency balloon catheter and multi-electrode circular diagnostic catheter
Primary Outcome Measure Information:
Title
Number of Participants With Early Onset Primary Adverse Events (PAEs): Death, Atrio-esophageal Fistula and Pulmonary Vein Stenosis
Description
A Primary AEs is an event which occurred within 90 days following initial ablation procedure. Primary AEs included: Death, atrio-esophageal fistula, and pulmonary vein stenosis.
Time Frame
Up to 90 days (post initial mapping and ablation procedure)
Title
Number of Participants With Early Onset PAEs: Myocardial Infraction, Cardiac Tamponade/Perforation, Thromboembolism, Stroke/Cerebrovascular Accident, Transient Ischemic Attack, Phrenic Nerve Paralysis, and Major Vascular Access Complication/Bleeding
Description
A Primary AEs is an event which occurred within the first week (7 days of the initial mapping and ablation procedure) which included myocardial infraction (MI), cardiac tamponade (CT)/perforation, thromboembolism, stroke/cerebrovascular accident (CVA), Transient ischemic attack (TIA), phrenic nerve paralysis (PNP), and major vascular access complication (MVAC)/bleeding following initial ablation procedure.
Time Frame
Up to 7 days (post initial mapping and ablation procedure)
Title
Percentage of Participants With Acute Procedural Success
Description
Acute procedural success is defined as confirmation of entrance block in treated pulmonary veins (PV) after adenosine and/or isoproterenol challenge (with or without the use of a focal catheter).
Time Frame
Day 1
Secondary Outcome Measure Information:
Title
Number of Participants With Individual PAE From Primary Composite
Description
A Primary AEs is an event which occurred within the first week (7 days of the initial mapping and ablation procedure) which included death, atrio-esophageal fistula (AE fistula) and pulmonary vein stenosis (PVST); and up to 90 days post procedure which included myocardial infraction (MI), cardiac tamponade (CT)/perforation, thromboembolism, stroke/cerebrovascular accident (CVA), Transient ischemic attack (TIA), phrenic nerve paralysis (PNP), and major vascular access complication (MVAC)/bleeding following initial ablation procedure.
Time Frame
Up to 7 days for MI, CT/perforation, thromboembolism, stroke/CVA, TIA, PNP and MVAC (initial mapping and ablation procedure) and up to 90 days for death, AE fistula, and PVST (post procedure)
Title
Number of Participants With Serious Adverse Device Effects (SADEs)
Description
An adverse device effect is an adverse event related to the to the device and or the procedure of the investigational medical device. SADE is an adverse device effect that has resulted in any of the consequences characteristic of an SAE.
Time Frame
Up to 405 Days
Title
Number of Participants With Serious Non-primary Adverse Events Within 7 Days (Early Onset), 8-30 Days (Peri-procedural) and Greater Than or Equal to (>=) 31 Days (Late Onset) of Initial Ablation Procedure
Description
Serious non-primary adverse event was defined as SAE that are not primary adverse events. Primary AEs included: Death, atrio-esophageal fistula, and pulmonary vein stenosis.
Time Frame
Within 7 Days (Early Onset), 8-30 Days (Peri-procedural) and >=31 Days (Late Onset) of Initial Ablation Procedure (Up to 405 Days)
Title
Number of Participants With Non-serious Adverse Events
Description
An AE is any untoward medical occurrence in participants whether or not related to the investigational medical device.
Time Frame
Up to 405 Days
Title
Number of Participants With Pre-and Post-ablation Asymptomatic and Symptomatic Cerebral Emboli
Description
Number of participants with pre-and post-ablation asymptomatic and symptomatic cerebral emboli was reported.
Time Frame
Pre-procedure, at Discharge, 1 Month and at unscheduled visit (Up to 405 Days)
Title
Number of Participants With Symptomatic and Asymptomatic Cerebral Emboli
Description
Number of participants with symptomatic and asymptomatic cerebral emboli was reported
Time Frame
Up to 405 Days
Title
Number of Participants With New or Worsening Neurologic Deficits
Description
Number of participants with new or worsening neurologic deficits was reported.
Time Frame
Pre-procedure, discharge, 1 Month, 3 Month and 6 Month
Title
Number of Participants With NIHSS Scores
Description
The National Institutes of Health Stroke Scale, or NIH Stroke Scale (NIHSS) is a tool used to objectively quantify the impairment caused by a stroke. The NIHSS is composed of 11 items, each of which scores a specific ability between 0 and 4. For each item, a score of 0 typically indicates normal function in that specific ability, while a higher score is indicative of some level of impairment. The individual scores from each item are summed to calculate a patient's total NIHSS score. The patient's total NIHSS score ranges from 0 (minimum) - 42 (maximum). Score 0 (no stroke symptoms); 1 - 4 (Minor stroke); 5-15 (Moderate stroke); 16-20 (Moderate to severe stroke); and 21-42 (Severe stroke).
Time Frame
Pre-procedure and at discharge (Up to 405 Days)
Title
Number of Participants With MoCA Scores
Description
Montreal Cognitive Assessment (MoCA) is used for detecting cognitive impairment, the scores range from 0 to 30. A score of 26 or higher is considered normal, patients with mild cognitive impairment (MCI) were scored an average of 22 and patients with significant cognitive impairment (SCI) were scored an average of 16.
Time Frame
Up to 405 Days
Title
Number of Participants With Hospitalization for Cardiovascular Events
Description
Hospitalization was defined as prolonged stay greater than or equal to (>=) 2 nights post index procedure or in-patient stay not concurrent with index procedure >= 1 calendar day. Hospitalization included cardiovascular events due to any cause post index procedure, regardless of protocol-defined serious/non-serious adverse events (AEs) or not. Hence this data was not contributed in serious Adverse events until met the AE definition.
Time Frame
Within 7 Days (Early Onset), 8-30 Days (Peri-procedural) and >=31 Days (Late Onset) of Initial Ablation Procedure (Up to 405 Days)
Title
Percentage of Participants With PVI Touch-up by Balloon and/or Focal Catheter Among All Targeted Veins and by Participants
Description
Percentage of participants with PVI touch-up by balloon and/or focal catheter among all targeted veins and by participants was reported. Most of the participants were ablated by Balloon catheter only while one participant was ablated with both Balloon and Focal catheters.
Time Frame
Up to 405 Days
Title
Percentage of Participants With Use of Focal Catheter Ablation for Non-PV Triggers
Description
Percentage of participants with use of focal catheter ablation for non-PV triggers was reported.
Time Frame
Up to 405 Days
Title
Percentage of Participants With Freedom From Documented Atrial Fibrillation (AF), Atrial Tachycardia (AT), or Atypical (Left Side) Atrial Flutter (AFL) Episodes or Documented Symptomatic AF/AT/AFL
Description
Percentage of participants with six-month arrythmia recurrence [defined as freedom from documented symptomatic or asymptomatic atrial fibrillation (AF), atrial tachycardia (AT), or atypical (left side) atrial flutter (AFL) episodes (episodes >30 seconds on arrhythmia monitoring device from Day 91 to 180 post the index procedure)] was reported.
Time Frame
Up to 6 Months
Title
Percentage of Participants With Freedom From Documented, AF, AT, or Atypical (Left Side) AFL Episodes or Documented Symptomatic AF/AT/AFL
Description
Twelve-month Arrythmia recurrence is defined as a documented symptomatic or asymptomatic episode >30 seconds on an arrhythmia monitoring device between day 91 to 365 post the index procedure.
Time Frame
Up to 12 Months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosed with Symptomatic Paroxysmal AF. Selected for atrial fibrillation (AF) ablation procedure for pulmonary vein isolation. Able and willing to comply with uninterrupted per-protocol anticoagulation requirements Age 18-75 years. Able and willing to comply with all pre-, post- and follow-up testing and requirements. Signed Patient Informed Consent Form. Exclusion Criteria: AF secondary to electrolyte imbalance, thyroid disease, or reversible or non-cardiac cause. Previous surgical or catheter ablation for AF. Anticipated to receive ablation outside the PV ostia and Cavo-triscuspid-isthmus (CTI) region Previously diagnosed with persistent, longstanding AF and/or continuous AF > 7 days, or > 48 hrs terminated by cardioversion. Any percutaneous coronary intervention (PCI) within the past 2 months. Valve repair or replacement and presence of a prosthetic valve. Any carotid stenting or endarterectomy. Coronary artery bypass grafting (CABG), cardiac surgery (e.g. ventriculotomy, atriotomy), or valvular cardiac surgical or percutaneous procedure within the past 6 months. Documented left atrium (LA) thrombus on baseline/pre-procedure imaging. LA antero posterior diameter > 50 mm Any PV with a diameter ≥ 26 mm Left Ventricular Ejection Fraction (LVEF) < 40%. Contraindication to anticoagulation (e.g. heparin). History of blood clotting or bleeding abnormalities. Myocardial infarction within the past 2 months. Documented thromboembolic event [including transient ischemic attack(TIA)] within the past 12 months. Rheumatic Heart Disease. Uncontrolled heart failure or New York Heart Association (NYHA) function class III or IV. Awaiting cardiac transplantation or other cardiac surgery within the next 12 months. Unstable angina. Acute illness or active systemic infection or sepsis. Diagnosed atrial myxoma or interatrial baffle or patch. Presence of implanted pacemaker or implantable cardioverter defibrillator (ICD). Significant pulmonary disease, (e.g. restrictive pulmonary disease, constrictive or chronic obstructive pulmonary disease) or any other disease or malfunction of the lungs or respiratory system that produces chronic symptoms. Significant congenital anomaly or medical problem that, in the opinion of the investigator, would preclude enrollment in this study. Women who are pregnant (as evidenced by pregnancy test if pre-menopausal), lactating, or who are of child bearing age and plan on becoming pregnant during the course of the clinical investigation. Enrollment in an investigational study evaluating another device, biologic, or drug. Has known pulmonary vein stenosis. Presence of intramural thrombus, tumor or other abnormality that precludes vascular access, or manipulation of the catheter. Presence of an Inferior Vena Cava (IVC) filter Presence of a condition that precludes vascular access. Life expectancy or other disease processes likely to limit survival to less than 12 months. Presenting contra-indication for the devices (e.g. transthoracic echocardiography (TTE), CT, etc.) used in the study, as indicated in the respective instructions for use. Categorized as a vulnerable population and requires special treatment with respect to safeguards of well-being Additional exclusion criteria for Neurological Assessment Evaluable (NAE) subjects: Contraindication to use of contrast agents for MRI such as advanced renal disease, etc. (at PI discretion) Presence of iron-containing metal fragments in the body Unresolved pre-existing neurological deficit.
Facility Information:
Facility Name
Na Homolce Hospital
City
Prague
Country
Czechia
Facility Name
Ospedale "F. Miulli"
City
Bari
Country
Italy
Facility Name
Centro Cardiologico Monzino
City
Milan
Country
Italy
Facility Name
Liverpool Heart and Chest Hospital
City
Liverpool
Country
United Kingdom
Facility Name
Bart's Health NHS Trust
City
London
Country
United Kingdom

12. IPD Sharing Statement

Citations:
PubMed Identifier
33450010
Citation
Schilling R, Dhillon GS, Tondo C, Riva S, Grimaldi M, Quadrini F, Neuzil P, Chierchia GB, de Asmundis C, Abdelaal A, Vanderlinden L, Tan T, Ding WY, Gupta D, Reddy VY. Safety, effectiveness, and quality of life following pulmonary vein isolation with a multi-electrode radiofrequency balloon catheter in paroxysmal atrial fibrillation: 1-year outcomes from SHINE. Europace. 2021 Jun 7;23(6):851-860. doi: 10.1093/europace/euaa382.
Results Reference
derived

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Multi-electrode Radiofrequency Balloon Catheter Use for the Isolation of the Pulmonary Veins.

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