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Efficacy and Safety Study of the Estech COBRA® Surgical System to Treat Patients With a History of Irregular Heart Beats

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. Identifier: NCT01683045
Recruitment Status : Terminated
First Posted : September 11, 2012
Last Update Posted : April 23, 2014
Information provided by (Responsible Party):
Endoscopic Technologies, Inc

Brief Summary:
The purpose of this study is to demonstrate that the Estech COBRA Surgical System is an effective treatment for patients with irregular heart beats who are undergoing heart surgery.

Condition or disease Intervention/treatment Phase
Persistent Atrial Fibrillation Device: The Estech COBRA® Surgical System Not Applicable

Detailed Description:
The objective of the trial is to demonstrate that the creation of epicardial and endocardial lesions with temperature-controlled radiofrequency (TCRF) ablation applied using the Estech COBRA® Surgical System during concomitant heart surgery is a safe and effective treatment for non-paroxysmal atrial fibrillation (AF).

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 6 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Ablation for the Treatment of Concomitant Atrial Fibrillation in Non-Paroxysmal Patients (ATTAC-AF)
Study Start Date : September 2012
Actual Primary Completion Date : January 2014
Estimated Study Completion Date : May 2014

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: The Estech COBRA® Surgical System Device: The Estech COBRA® Surgical System
The Estech COBRA® Surgical System has been designed to create epicardial and endocardial lesions on the heart using temperature controlled radiofrequency (TCRF) ablation with the Estech COBRA surgical probes. Temperature control provides a meaningful endpoint, maintaining tissue at safe yet effective temperatures to produce the desired lesion set. Internal probe cooling and advanced suction helps to ensure reproducible transmural (full-thickness) endocardial or epicardial lesions.
Other Names:
  • Estech COBRA Cooled™ Surgical Probe
  • Estech COBRA Adhere™ XL Surgical System
  • Estech COBRA Adhere™ XL 2 Surgical System
  • Estech COBRA® Revolution Bipolar Clamp

Primary Outcome Measures :
  1. Primary Efficacy Endpoint [ Time Frame: The primary efficacy endpoint will be assessed following the blanking interval through Month 12. ]
    Proportion of subjects that achieve procedural and therapeutic success. Procedural success is defined as the performance of the protocol specified lesions with the designated devices. Therapeutic success is defined as freedom from AF, AFL (atrial flutter) and AT (atrial tachycardia, not including sinus tachycardia) following the blanking interval through Month 12.

  2. Primary Safety Endpoint [ Time Frame: The primary safety endpoint will be assessed within 30 days of the procedure or hospital discharge, whichever is later. ]

    A composite safety endpoint consisting of the proportion of subjects that experience one or more of the following early onset (i.e., within 30 days of the TCRF ablation procedure or hospital discharge, whichever is later) serious adverse events (SAEs):

    • Cardiac death;
    • Stroke and transient ischemic attack (TIA);
    • Myocardial infarction (MI);
    • Excessive bleeding; or
    • Atrioesophageal fistula.

Secondary Outcome Measures :
  1. Secondary Efficacy Endpoint [ Time Frame: The secondary efficacy endpoints will be assessed following the procedure through the 12 month follow-up visit. ]

    The secondary efficacy endpoints include:

    • Proportion of subjects that achieve bilateral pulmonary vein conduction block.
    • AF burden at 6 and 12 months based on the proportion of time a subject is in AF (% of 24 hours) from the 24-hour continuous ECG monitor.

  2. Secondary Safety Endpoint [ Time Frame: The secondary safety endpoints will be assessed up to 3 years post procedure. ]

    The proportion of subjects with acute onset post-surgical symptomatic diaphragmatic paralysis that is still present at the Month 12 follow-up visit.

    The proportion of subjects reporting one or more SAEs for each follow-up interval. The intervals will include the period from:

    • the surgical procedure for the surgical TCRF ablation through the Day 30 follow-up visit;
    • the Day 30 follow-up visit through the Month 3 follow-up visit;
    • the Month 3 follow-up visit through the Month 6 follow-up visit; and
    • the Month 6 follow-up visit through the Month 12 follow-up visit. Additionally, the proportion of subjects reporting one or more SAEs annually for years 2 and 3 post procedure.

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

All subjects are required to meet the following inclusion criteria in order to be considered eligible for participation in this trial:

  1. Subject is scheduled to undergo elective on-pump cardiac surgical procedure(s) for one or more of the following:

    1. Mitral valve repair or replacement,
    2. Aortic valve repair or replacement,
    3. Tricuspid valve repair or replacement, or
    4. Coronary Artery Bypass procedures;
  2. Subject has history of a non-paroxysmal form of AF for greater than 3 months and has failed at least one attempt at electrical cardioversion or had a successful attempt at electrical cardioversion but had a recurrence of AF within 30 days of the cardioversion;
  3. Age 18 to 80 years old;
  4. Left ventricular ejection fraction (LVEF) ≥ 30%;
  5. Subject has no contraindications to intraoperative transesophageal echocardiography;
  6. Subject has a life expectancy greater than 12 months; and
  7. Willing and capable of providing Informed Consent to undergo surgery and participate in all examinations and follow-ups associated with this clinical trial.

A subject is considered to have failed electrical cardioversion if they did not achieve sinus rhythm for at least 30 seconds following the attempted cardioversion.

Exclusion Criteria:

Subjects will be excluded from participating in this trial if they meet any of the following exclusion criteria:

  1. History of non-paroxysmal AF less than 3 months or for more than 5 years;
  2. History of prior cardiac ablative surgical or catheter-based therapy;
  3. Previous cardiac surgery (redo) or other intrapericardial procedures;
  4. Class IV NYHA heart failure;
  5. Known carotid artery stenosis greater than 80% or previous carotid endarterectomy;
  6. Wolff-Parkinson-White syndrome;
  7. Need for emergent cardiac surgery (e.g., cardiogenic shock);
  8. Untreated hyperthyroidism;
  9. Untreated hypothyroidism;
  10. Acute pulmonary disease;
  11. Electrolyte imbalance;
  12. History of myocarditis;
  13. Presence of a previously implanted device in or adjacent to the treatment target area that may alter the delivery of therapy (e.g., valvular prosthesis or ring, pacemaker with leads in coronary sinus or internal defibrillator leads);
  14. History of pericarditis;
  15. Previous left phrenic nerve paralysis;
  16. Bullous lung disease;
  17. Presence of active endocarditis, or local or systemic infection;
  18. Recent myocardial infarction (< 3 months);
  19. Renal failure requiring dialysis or hepatic failure or creatinine of >2 mg/dL preoperatively;
  20. Antiarrhythmic drug therapy required for the treatment of a ventricular arrhythmia;
  21. Preoperative need for an intra-aortic balloon pump or intravenous inotropes;
  22. Severe peripheral arterial occlusive disease defined as claudication with minimal exertion;
  23. Therapy resulting in compromised tissue integrity including: thoracic radiation, chemotherapy, long term treatment with oral or injected steroids, or known connective tissue disorders;
  24. Documented left atrial size of 6 cm or more;
  25. History of cerebrovascular disease or accident, including stroke or transient ischemic attack (TIA) within 6 months prior to enrollment;
  26. Known contraindication to anticoagulant therapy or inability to comply with anticoagulant therapy;
  27. Pregnancy, planned pregnancy (females of childbearing potential must have a negative pregnancy test prior to enrollment and agree not to become pregnant during the trial) or breastfeeding;
  28. Forced expiratory volume in 1 second less than 30% of predicted value or need for home oxygen therapy; or
  29. Surgical management of hypertrophic obstructive cardiomyopathy.

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 identifier (NCT number): NCT01683045

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United States, Arizona
Banner Good Samaritan Medical Center
Mesa, Arizona, United States, 85206
United States, Connecticut
Hartford Hospital
Hartford, Connecticut, United States, 06102
United States, Georgia
Saint Joseph's Hospital of Atlanta
Atlanta, Georgia, United States, 30342
United States, Illinois
North Shore Univ. Health System
Evanston, Illinois, United States, 60201
Advocate Christ Medical Center
Oak Lawn, Illinois, United States, 60453
United States, Kansas
The Univ. of Kansas Hospital
Kansas City, Kansas, United States, 66160
United States, Michigan
Univ. of Michigan Cardiovascular Center
Ann Arbor, Michigan, United States, 48109
United States, Minnesota
Mayo Clinic / St. Mary's Hospital
Rochester, Minnesota, United States, 55905
United States, New York
Lenox Hill Hospital / North Shore-LIJ Health System
New York, New York, United States, 10075
Mohawk Valley Heart Institute / St. Elizabeth Medical Center
Utica, New York, United States, 13501
United States, South Carolina
Sisters of Charity, Providence Hospital
Columbia, South Carolina, United States, 29204
United States, Virginia
Fairfax Hospital, Department of Cardiovascular and Thoracic Surgery
Falls Church, Virginia, United States, 22041
United States, Wisconsin
Aurora St. Luke's Medical Center
Milwaukee, Wisconsin, United States, 53215
Sponsors and Collaborators
Endoscopic Technologies, Inc
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Principal Investigator: David K Swanson, Ph.D. Endoscopic Technologies, Inc
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Responsible Party: Endoscopic Technologies, Inc Identifier: NCT01683045    
Other Study ID Numbers: 400-02
First Posted: September 11, 2012    Key Record Dates
Last Update Posted: April 23, 2014
Last Verified: April 2014
Keywords provided by Endoscopic Technologies, Inc:
non-paroxysmal atrial fibrillation
persistent atrial fibrillation
atrial fibrillation
heart palpitations
irregular heart beat
temperature-controlled radiofrequency ablation
radiofrequency energy
TCRF energy
RF energy
epicardial and endocardial lesions
concomitant heart surgery
surgical ablation
Additional relevant MeSH terms:
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Atrial Fibrillation
Arrhythmias, Cardiac
Heart Diseases
Cardiovascular Diseases
Pathologic Processes