Adjunctive Renal Denervation in the Treatment of Atrial Fibrillation

Not Applicable

Completed

Conditions: Uncontrolled Hypertension
Atrial Fibrillation

Interventions: Device: Boston Scientific Vessix Renal Denervation System

Registration Number: NCT01635998

Lead Sponsor: Vivek Reddy

Brief Summary: The objective of the H-FIB trial is to determine the role of renal sympathetic denervation in the prevention of Atrial Fibrillation (AF) recurrence in patients with hypertension for whom a catheter-based AF ablation procedure is planned. Patients will be randomized to either AF catheter ablation (usual therapy) or AF catheter ablation plus renal sympathetic denervation.

Detailed Description: The purpose of this study is to examine the potential additional benefit of performing renal sympathetic denervation at the same time as an AF ablation procedure, in order to improve the long-term success of the AF procedure.

To take part in this study, you must meet all study requirements. Screening visit tests and procedures such as a physical exam, blood pressure, review of medical history, blood sample, and a Transthoracic Echocardiogram (TTE) are done to see if you are eligible to be in the study.

Patients who qualify for the study and provide consent will undergo catheter ablation for AF. Very thin electrode catheters, similar to long wires, will be inserted into blood vessels in the groin. Using the ablation catheter, we will "ablate" or damage the tissue adjacent to your pulmonary veins that is not behaving normally.

Immediately following the catheter ablation, patients will undergo a renal angiogram in order to assess suitability for catheter-based renal sympathetic denervation. A renal angiogram is an x-ray study of the blood vessels in the kidney to evaluate for blockage, and abnormalities that could be affecting the blood supply to the kidney. It is performed by injecting contrast dye through a catheter (a tiny tube) into the blood vessels of the kidney.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 50

Inclusion Criteria

Inclusion Criteria
Age ≥ 18 years of age
History of AF (paroxysmal or persistent) and planned for a guideline-supported catheter ablation procedure
History of significant hypertension (defined as SBP ≥160 mm Hg and/or DBP ≥100 mmHg) and receiving treatment with at least one anti-hypertensive medication OR Clinical History of hypertension and receiving treatment with at least two anti-hypertensive medications (specifically for blood pressure reduction).
Renal vasculature is accessible as determined by intra-procedural renal angiography.
Ability to understand the requirements of the study
Willingness to adhere to study restrictions, comply with all post-procedural follow-up requirements and to sign informed consent

Exclusion Criteria

Inability to undergo AF catheter ablation (e.g., presence of a left atrial thrombus, contraindication to all anticoagulation)
Prior left atrial ablation for an atrial arrhythmia (before this index procedure)
Patients with NYHA class IV congestive heart failure
Individual has known secondary hypertension
Individual has renal artery anatomy that is ineligible for treatment including:
1. Inability to access renal vasculature
2. Main renal arteries < 3 mm in diameter or < 20 mm in length.
3. Hemodynamically or anatomically significant renal artery abnormality or stenosis in either renal artery which, in the eyes of the operator, would interfere with safe cannulation of the renal artery or meets standards for surgical repair or interventional dilation.
4. A history of prior renal artery intervention including balloon angioplasty or stenting that precludes a possibility of ablation treatment.
Individual has an estimated glomerular filtration rate (eGFR) of less than 45mL/min/1.73m2, using the MDRD calculation.
Individual has a single functioning kidney (either congenitally or iatrogenically).
Individual is pregnant or nursing.
Life expectancy <1 year for any medical condition

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Intervention arm	Boston Scientific Vessix Renal Denervation System	These subjects will undergo routine catheter ablation of atrial fibrillation PLUS renal sympathetic denervation with the Boston Scientific Vessix Renal Denervation System.

Primary Outcome Measures

Name	Time	Method
Anti-arrhythmic Drug (AAD)-Free Single-procedure Freedom From Atrial Fibrillation Recurrence	up to 12 months	The primary endpoint of this study is anti-arrhythmic drug (AAD)-free single-procedure freedom from AF recurrence through 12 months (not including a 90 day blanking period).

Secondary Outcome Measures

Name	Time	Method
AAD-free Single-procedure Freedom From AF Recurrence	up to 24 months	AAD-free single-procedure freedom from AF recurrence through 24 months (not-including recurrences within the first 90 days of the initial ablation procedure)
Freedom From AF Recurrence Despite Taking AADs	up to 24 months	Freedom from AF recurrence through 24 months (not-including the pre-defined 90 day blanking period) despite taking AADs
Blood Pressure Control as Compared to Baseline	baseline, 6 months, 12 months, and 24 months	Blood pressure control between the two groups as compared to baseline at 6 months, 12 months and 24 months.
Number of Participants With Major Adverse Cardiac Events (MACE)	within 12 months of randomization	Number of Participants with Major adverse cardiac events (MACE) defined as a non-weighted composite score of: death, stroke, CHF hospitalization, and clinically diagnosed thromboembolic events other than stroke and hemorrhage requiring transfusion within 12 months of randomization
Number of Participants With Serious Adverse Events (SAE)	up to 24 months	SAE-any experience that results in a fatality or is life threatening; results in significant or persistent disability; requires or prolongs hospitalization; results in congenital anomaly/birth defect; or represents other significant hazards or potentially serious harm to research subjects or others, in the opinion of the investigators. Important medical events that may not result in above may be considered a SAE when, based upon appropriate medical judgment, they may jeopardize the patient and may require medical or surgical intervention to prevent one of the outcomes listed in this definition
Left Atrial (LA) Size	at baseline and at 12 months	LA size by TTE at baseline and at 12 months
Ejection Fraction (EF)	at baseline and at 12 months	Ejection fraction (EF) is a measurement, expressed as a percentage, of how much blood the left ventricle pumps out with each contraction. A normal heart's ejection fraction may be between 50 and 70 percent.
Number of Participants With Procedure Adverse Events	up to 24 months	Causality will be defined as adverse events that, after careful medical evaluation, are considered with a high degree of certainty to be related to the intervention (AF ablation ± renal sympathetic denervation).
Number of Anti-hypertensive Medications	baseline and 24 months	Total number of anti-hypertensive medications at study end, compared between the two treatment arms
Atrial Fibrillation Effect on QualiTy-of-life Questionnaire (AFEQT)	baseline, 12 months and 24 months	The change in quality of life (QoL) from baseline to 12 months as measured by AFEQT, a 20- item instrument. Full range from 0 to 100, with higher score indicates higher level of QoL.

Trial Locations

Locations (8): Medical University of South Carolina
🇺🇸
Charleston, South Carolina, United States
Massachusetts General Hospital
🇺🇸
Boston, Massachusetts, United States
Brigham and Women's Hospital
🇺🇸
Boston, Massachusetts, United States
Mount Sinai Hospital
🇺🇸
New York, New York, United States
Regional Cardiology Associates
🇺🇸
Sacramento, California, United States
Siberian Biomedical Research Center Ministry of Health Russian Federation
🇷🇺
Novosibirsk, Russian Federation
Na Homolce Hospital
🇨🇿
Prague, Czechia
University of Kansas Medical Center
🇺🇸
Kansas City, Kansas, United States