aMAZE Study: LAA Ligation Adjunctive to PVI for Persistent or Longstanding Persistent Atrial Fibrillation
- Conditions
- Atrial Fibrillation
- Interventions
- Device: Pulmonary Vein IsolationDevice: LARIAT + PVI
- Registration Number
- NCT02513797
- Lead Sponsor
- AtriCure, Inc.
- Brief Summary
This study is a prospective, multicenter, randomized (2:1) controlled study to evaluate the safety and effectiveness of the LARIAT System to percutaneously isolate and ligate the Left Atrial Appendage from the left atrium as an adjunct to planned pulmonary vein isolation (PVI) catheter ablation in the treatment of subjects with symptomatic persistent or longstanding persistent atrial fibrillation.
This study will be conducted in two stages:
* Limited Early Stage (Stage 1): up to 250 subjects at up to 65 sites. (COMPLETED, transitioned to Stage 2)
* Pivotal Stage/ Phase III (Stage 2): up to 600 subjects at up to 65 sites. (COMPLETED) All subjects from both stages will be included in the primary analysis.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 600
- Documented diagnosis of symptomatic continuous persistent or longstanding persistent non-valvular atrial fibrillation
- Failed at least one Class I or III Antiarrythmic drug (AAD) and therefore, eligible and intended for standard of care catheter ablation;
- Life expectancy ≥ 1 year;
- Willing and able to return to and comply with scheduled follow-up visits and tests; and
- Willing and able to provide written informed consent
- Prior procedure involving opening of the pericardium or entering the pericardial space (e.g., coronary artery bypass graft, heart transplantation, valve surgery) where adhesions are suspected;
- Any prior epicardial ablation or any type of left-sided atrial ablation procedure;
- LA diameter > 6 cm as measured by computerized tomography and confirmed by the imaging core laboratory;
- Documented embolic stroke, transient ischemic attach or suspected neurologic event within 3 months prior to the planned study intervention;
- Currently exhibits New York Heart Association Class IV heart failure symptoms;
- Documented history of right heart failure specifically when right ventricle exceeds the left ventricular size;
- Documented history of myocardial infarction (MI) within 3 months prior to the planned study intervention;
- Documented history of unstable angina within 3 months prior to the planned study intervention;
- Documented history of cardiogenic shock, hemodynamic instability or any medical condition in which intra-aortic balloon pump (IABP) therapy is clinically indicated within 3 months prior to the planned study intervention;
- Documented symptomatic carotid disease, defined as > 70% stenosis or > 50% stenosis with symptoms;
- Diagnosed active local or systemic infection, septicemia or fever of unknown origin at tme of baseline screening;
- Chronic renal insufficiency defined as eGFR < 30 mL/min/1.73m2 within 3 months prior to planned study intervention;
- End Stage Renal Disease (ESRD) or documented history of renal replacement / dialysis;
- Current documented history of clinically significant liver disease which predisposes the subject to significant bleeding risk (clinically defined by the treating physician);
- Any history of thoracic radiation with the exception of localized radiation treatment for breast cancer;
- Current documented use of long-term treatment with oral corticoid steroids, not including use of inhaled steroids for respiratory diseases;
- Active pericarditis;
- Active endocarditis;
- Any documented history or autoimmune disease associated with pericarditis;
- Evidence of Pectus Excavatum (documented and clinically defined by the treating physician);
- Untreated severe scoliosis (documented and clinically defined by treating physician);
- Documented Left Ventricular Ejection Fraction (LVEF) < 30% within 30 days prior to planned intervention;
- Documented presence of implanted congenital defect closure devices, (e.g., atrial septal defect, patent foramen ovale or ventricular septal defect device);
- Previously attempted occlusion of the left atrial appendage (by any surgical or percutaneous method);
- Inability, or unwillingness or contraindication to undergo TEE or CTA imaging or 24-hour Holter monitoring;
- Body Mass Index (BMI) > 40;
- Evidence of active Graves disease;
- Current untreated hypothyroidism;
- Any contraindication to suture, endovascular device, or other minimally invasive techniques including percutaneous, transseptal, and/or sub-xiphoid access;
- Subject is pregnant or plans / desires to get pregnant within next 12 months;
- Current enrollment in an investigation or study of an investigational device or investigational drug that would interfere with this study and the required follow up;
- Mental impairment or other psychiatric conditions which may not allow patient to understand the nature, significance and scope of the study;
- Any other criteria, medical illness or comorbidity which would make the subject unsuitable to participate in this study as determined by the clinical site Primary Investigator;
Additional Exclusion Criteria: Based on Screening / Pre-procedure Imaging
Subjects will also be excluded if they meet any of the following:
-
Based on screening computed tomography angiography performed within 90 days prior to study intervention as confirmed by the core lab:
- Left atrial appendage morphology: Superior-posterior oriented left atrial appendage (i.e. superior C shape), that has Left atrial appendage distal apex extending posterior to the ostium of the appendage.
- Left atrial appendage positioned behind the pulmonary artery; or
- All other left atrial morphology: Left atrial appendage LARIAT approach width > 50 mm.
-
Based on a peri-procedural imaging (transesophageal echocardiography) at time of LARIAT or catheter ablation) and confirmed by institution's designated LARIAT echocardiographer:
- Intracardiac thrombus; or
- Significant mitral valve stenosis (i.e., mitral valve stenosis < 1.5cm2)
NOTE: It is anticipated that a majority of subjects enrolled in the aMAZE Trial will be elderly US Medicare beneficiaries. Therefore, the results from the aMAZE Trial are expected to be generalizable to the Medicare population.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description PVI Catheter Ablation Group Pulmonary Vein Isolation Perform pulmonary vein isolation (PVI) catheter ablation procedure using a contact force sensing, irrigated radiofrequency catheter approved by FDA for the treatment of atrial fibrillation. LARIAT + PVI Treatment Group LARIAT + PVI Percutaneously isolate and ligate the Left Atrial Appendage (LAA) from the left atrium (LA) with the LARIAT System prior to planned pulmonary vein isolation (PVI) catheter ablation LARIAT + PVI Treatment Group Pulmonary Vein Isolation Percutaneously isolate and ligate the Left Atrial Appendage (LAA) from the left atrium (LA) with the LARIAT System prior to planned pulmonary vein isolation (PVI) catheter ablation
- Primary Outcome Measures
Name Time Method Freedom from episodes of atrial fibrillation > 30 seconds at 12 months post index pulmonary vein isolation 12 months following Pulmonary Vein Isolation catheter ablation procedure Measured by 24-hour Holter Monitoring
- Secondary Outcome Measures
Name Time Method Freedom from any atrial fibrillation/atrial tachycardia/atrial flutter recurrence defined as any episode > 30 seconds with or without AAD Following the 90 day blanking period through 12 months post-index pulmonary vein isolation Measured by 24-hour Holter Monitoring
Composite endpoint of stroke of any cause and systemic embolism as adjudicated by the clinical events committee 12 months following index pulmonary vein isolation
Trial Locations
- Locations (53)
University of Southern California
🇺🇸Los Angeles, California, United States
Emory University Hospital
🇺🇸Atlanta, Georgia, United States
Johns Hopkins
🇺🇸Baltimore, Maryland, United States
The Valley Hospital
🇺🇸Ridgewood, New Jersey, United States
Cardiovascular Institute of the South Clinical Research Corporation
🇺🇸Houma, Louisiana, United States
Hackensack University Medical Center
🇺🇸Hackensack, New Jersey, United States
Maimonides Medical Center
🇺🇸Brooklyn, New York, United States
Trident Medical Center
🇺🇸Charleston, South Carolina, United States
Texas Cardiac Arrhythmia Research Foundation
🇺🇸Austin, Texas, United States
Northwestern University / Bluhm Cardiovascular Institute
🇺🇸Chicago, Illinois, United States
The Queen's Medical Center
🇺🇸Honolulu, Hawaii, United States
University of Kansas Medical Center Research Institute
🇺🇸Kansas City, Kansas, United States
Kansas City Cardiac Arrhythmia Research
🇺🇸Overland Park, Kansas, United States
Arizona Arrhythmia Research Center
🇺🇸Phoenix, Arizona, United States
Phoenix Cardiovascular Research Group
🇺🇸Phoenix, Arizona, United States
DaVita Medical Group
🇺🇸Las Vegas, Nevada, United States
Scripps Clinic
🇺🇸La Jolla, California, United States
Santa Barbara Cottage Hospital
🇺🇸Santa Barbara, California, United States
University of California San Diego
🇺🇸La Jolla, California, United States
University of California San Francisco
🇺🇸San Francisco, California, United States
Piedmont Athens Regional Cardiology
🇺🇸Athens, Georgia, United States
Yale University School of Medicine
🇺🇸New Haven, Connecticut, United States
St. Vincent's HealthCare
🇺🇸Jacksonville, Florida, United States
Advocate Christ Medical Center
🇺🇸Oak Lawn, Illinois, United States
Prairie Education and Research Cooperative
🇺🇸Springfield, Illinois, United States
Loyola University Center for Heart and Vascular Medicine
🇺🇸Maywood, Illinois, United States
Northwestern Medicine Central DuPage Hospital
🇺🇸Winfield, Illinois, United States
Community Hospital
🇺🇸Munster, Indiana, United States
Iowa Heart Center
🇺🇸West Des Moines, Iowa, United States
University of Kentucky
🇺🇸Lexington, Kentucky, United States
Ochsner Medical Center
🇺🇸New Orleans, Louisiana, United States
UP Health System- Marquette
🇺🇸Marquette, Michigan, United States
St. Luke's Hospital
🇺🇸Kansas City, Missouri, United States
New Mexico Heart Institute
🇺🇸Albuquerque, New Mexico, United States
Morristown Medical Center
🇺🇸Morristown, New Jersey, United States
Ohio State University Wexner Medical Center
🇺🇸Columbus, Ohio, United States
New York University Langone Medical Center
🇺🇸New York, New York, United States
The Ohio Health Research Institute
🇺🇸Columbus, Ohio, United States
Southern Oregon Cardiology
🇺🇸Medford, Oregon, United States
Oregon Health & Science University
🇺🇸Portland, Oregon, United States
Bryn Mawr Medical Specialists Association / Bryn Mawr Hospital
🇺🇸Bryn Mawr, Pennsylvania, United States
Medical University of South Carolina
🇺🇸Charleston, South Carolina, United States
University of Pittsburgh Medical Center
🇺🇸Pittsburgh, Pennsylvania, United States
Vanderbilt University
🇺🇸Nashville, Tennessee, United States
Houston Methodist
🇺🇸Houston, Texas, United States
Austin Heart
🇺🇸Austin, Texas, United States
Baylor Plano Scott & White Research Institute Heart Hospital
🇺🇸Plano, Texas, United States
Baylor - St. Luke's Medical Center
🇺🇸Houston, Texas, United States
University of Texas Health Science Center at San Antonio
🇺🇸San Antonio, Texas, United States
Christus Trinity Mother Frances Health System
🇺🇸Tyler, Texas, United States
Providence Sacred Heart Medical Center
🇺🇸Spokane, Washington, United States
Stanford University
🇺🇸Stanford, California, United States
Montefiore Medical Center
🇺🇸Bronx, New York, United States