AzTrials
AzTrials

Persistent Atrial FibrillationNCT04190186

Hybrid Ablation Plus Medical Therapy for Persistent Atrial Fibrillation

A study testing Insertable Cardiac Monitor in people with Persistent Atrial Fibrillation, run by University of Rochester at 4 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

This clinical trial is designed to compare two management strategies for the treatment of asymptomatic/subclinical atrial fibrillation after ablation based on data from the Biotronik ICM (BioMonitor3® or future generation of Biotronik ICM). Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Persistent Atrial Fibrillation
What is being tested?
Insertable Cardiac Monitor
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
55 participants
Where
4 sitesUnited States
Study dates
25 Jun 2020to 15 Feb 2024
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • 18 years of age or older
  • History of persistent atrial fibrillation (sustained AF episode lasting more than 7 days, but less than a year)
  • Planned to undergo first AF ablation with successful Biotronik ICM implant before or at time of ablation

Who cannot join

  • Paroxysmal atrial fibrillation
  • Long persistent atrial fibrillation (continuous atrial fibrillation that lasts more than 1 year)
  • Permanent atrial fibrillation
  • Left atrial diameter of 60 mm or greater
  • Patients with CHF status prohibiting EP study and ablation, but may be re-considered for enrollment later after effective treatment
  • Patients with metabolic derangements (e.g. renal/hepatic failure, electrolyte disturbance, etc.), prohibiting EP study and ablation or antiarrhythmic medical therapy (e.g. dofetilide, sotalol or amiodarone, etc.)
Show all 11Show fewer
  • Patients with an intra-cardiac thrombus, but may be re-considered for enrollment later after effective treatment
  • Serious known concomitant disease with a life expectancy of < 1 year
  • Pregnancy or nursing
  • Unwilling or unable to give informed consent
  • Existing CIED such as pacemaker or ICD

Trial locations and contacts

4 sites in 1 country.

United States4 sites
  • Rochester Regional Health

    Rochester, New York, 14621

  • University of Rochester

    Rochester, New York, 14642

  • Cardiology Associates Research, LLC

    Tupelo, Mississippi, 38801

  • Michigan Heart, PC

    Ypsilanti, Michigan, 48197

Other trials in United States

About this study

Official title: Hybrid Ablation Plus Medical Therapy for Persistent Atrial Fibrillation (HYBRID AF)

This clinical trial is designed to compare two management strategies for the treatment of asymptomatic/subclinical atrial fibrillation after ablation based on data from the Biotronik ICM (BioMonitor3® or future generation of Biotronik ICM).

Read the detailed description

In this study, subjects will be randomized (1:1) to conventional AF management vs. Biotronik ICM-guided AF management following ablation for persistent AF. Subjects will be followed for 15 months including a 3 month blanking period following AF ablation. The study subject population will include subjects with persistent atrial fibrillation (sustained AF episode lasting more than 7 days, but less than 1 year), according to current guideline indications for persistent AF ablation and ICM (Biotronik ICM) implantation.

Being tested
Insertable Cardiac Monitor
Keywords
Biotronik BioMonitor, ICM, AF Ablation, Atrial arrhythmia
Medical subject headings
Atrial Fibrillation

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Insertable Cardiac MonitorDevice

    Also called BioMonitor3® or future generation of Biotronik ICM

    Implantable device that provides accurate daily transmission of cardiac electrical data for arrhythmia detection.

Study groups in NCT04190186
Study groupRoleWhat they receive
Biotronik ICM-guided AF managementActive comparatorICM obtained data will be actively used to guide and monitor treatment .
Receives: Device: Insertable Cardiac Monitor
Conventional AF ManagementNo interventionTreating physicians/nurses will be blinded to the AF episodes data from the monitor, but will be provided information on asystole, or ventricular arrhythmia events (for safety).

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Atrial Fibrillation (AF) Burden Defined as the Mean Amount of Time Spent in AF Over a Pre-specified Period of Time (Excluding Short AF Episodes of ≤30 Seconds) by the Biotronik ICM (BioMonitor3® or Future Generation of Biotronik ICM).

    In the present study AF burden will be assessed at 3-month intervals during the 12 months following the blanking period (3-months post-ablation), and the difference at the end of the follow-up period of one year will serve as the primary comparison outcome between the two treatment groups.

    Measured: Between months 3 and 15 after the ablation procedure (to exclude the first 3 month blanking period)

Secondary outcomes (10)
  1. Number of Participants With Clinically Significant (>30 Min) Atrial Arrhythmia (Atrial Fibrillation, Atrial Flutter or Atrial Tachycardia) as Detected and Documented by Biotronik ICM After the Performance of the Index AF Ablation Procedure.

    Measured: Between enrollment and 15 months (excluding the initial 3-month blanking period) (assessed in a recurrent event analysis).

  2. Number of Participants With Symptomatic AF Recurrence (Regardless of Duration).

    Measured: Between enrollment and 15 months.

  3. Number of Participants With Repeat AF Ablation.

    Measured: Between enrollment and 15 months.

  4. Number of Participants With Cardiac Hospitalization.

    Measured: Between enrollment and 15 months.

  5. Number of Deaths.

    Measured: Between enrollment and 15 months.

  6. Number of Participants With Healthcare Utilization, Defined as Hospitalization for Any Cause, ED Visits, and Unplanned Office Visits.

    Measured: Between enrollment and 15 months.

  7. Number of Participants With Atrial Flutter or Tachycardia.

    Incidence of atrial flutter or tachycardia after the index ablation procedure

    Measured: Between months 3 and 15 after the ablation procedure (to exclude the first 3 month blanking period)

  8. Number of Participants With Incidence of Repeat Procedures.

    Measured: Between months 3 and 15 after the ablation procedure (to exclude the first 3 month blanking period)

  9. Number of Participants With Major Adverse Events Requiring Rehospitalization During Follow-up.

    Measured: Between months 3 and 15 after the ablation procedure (to exclude the first 3 month blanking period)

  10. Quality of Life as Assessed by the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) Questionnaire

    The Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire is a validated, disease-specific instrument used to assess quality of life in individuals with atrial fibrillation. It includes 20 questions across four domains: Symptoms, Daily Activities, Treatment Concern, and Treatment Satisfaction.

    The AFEQT provides both domain-specific scores and an overall total score. Scores for each domain and the Total Score range from 0 to 100. Higher scores indicate better quality of life, with 100 representing no symptoms or limitations and 0 representing severe symptoms or limitations. The Total Score is calculated by averaging the scores from the three core domains (Symptoms, daily activities, and treatment concern).

    Measured: Between months 3 and 15 after the ablation procedure (to exclude the first 3 month blanking period)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 Dec 2019
  2. Study start25 Jun 2020
  3. Primary completion15 Feb 2024
  4. Study completion15 Feb 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
55 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04190186
Sponsor's protocol ID
00004318
Status last verified
Jul 2025
First submitted
20 Nov 2019
Last updated
29 Jul 2025
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
No

Publications

  • Verma A, Jiang CY, Betts TR, Chen J, Deisenhofer I, Mantovan R, Macle L, Morillo CA, Haverkamp W, Weerasooriya R, Albenque JP, Nardi S, Menardi E, Novak P, Sanders P; STAR AF II Investigators. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med. 2015 May 7;372(19):1812-22. doi: 10.1056/NEJMoa1408288.

    PubMed 25946280
  • Huang DT, Monahan KM, Zimetbaum P, Papageorgiou P, Epstein LM, Josephson ME. Hybrid pharmacologic and ablative therapy: a novel and effective approach for the management of atrial fibrillation. J Cardiovasc Electrophysiol. 1998 May;9(5):462-9. doi: 10.1111/j.1540-8167.1998.tb01837.x.

    PubMed 9607453
  • Kirchhof P, Calkins H. Catheter ablation in patients with persistent atrial fibrillation. Eur Heart J. 2017 Jan 1;38(1):20-26. doi: 10.1093/eurheartj/ehw260. Epub 2016 Jul 7.

    PubMed 27389907
  • Willems S, Khairy P, Andrade JG, Hoffmann BA, Levesque S, Verma A, Weerasooriya R, Novak P, Arentz T, Deisenhofer I, Rostock T, Steven D, Rivard L, Guerra PG, Dyrda K, Mondesert B, Dubuc M, Thibault B, Talajic M, Roy D, Nattel S, Macle L; ADVICE Trial Investigators*. Redefining the Blanking Period After Catheter Ablation for Paroxysmal Atrial Fibrillation: Insights From the ADVICE (Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination) Trial. Circ Arrhythm Electrophysiol. 2016 Aug;9(8):e003909. doi: 10.1161/CIRCEP.115.003909.

    PubMed 27516462
  • Schreiber D, Rostock T, Frohlich M, Sultan A, Servatius H, Hoffmann BA, Luker J, Berner I, Schaffer B, Wegscheider K, Lezius S, Willems S, Steven D. Five-year follow-up after catheter ablation of persistent atrial fibrillation using the stepwise approach and prognostic factors for success. Circ Arrhythm Electrophysiol. 2015 Apr;8(2):308-17. doi: 10.1161/CIRCEP.114.001672. Epub 2015 Mar 5.

    PubMed 25744570
  • Reiffel JA, Camm AJ, Belardinelli L, Zeng D, Karwatowska-Prokopczuk E, Olmsted A, Zareba W, Rosero S, Kowey P; HARMONY Investigators. The HARMONY Trial: Combined Ranolazine and Dronedarone in the Management of Paroxysmal Atrial Fibrillation: Mechanistic and Therapeutic Synergism. Circ Arrhythm Electrophysiol. 2015 Oct;8(5):1048-56. doi: 10.1161/CIRCEP.115.002856. Epub 2015 Jul 30.

    PubMed 26226999
  • Tondo C, Iacopino S, Pieragnoli P, Molon G, Verlato R, Curnis A, Landolina M, Allocca G, Arena G, Fassini G, Sciarra L, Luzi M, Manfrin M, Padeletti L; ClinicalService 1STOP Project Investigators. Pulmonary vein isolation cryoablation for patients with persistent and long-standing persistent atrial fibrillation: Clinical outcomes from the real-world multicenter observational project. Heart Rhythm. 2018 Mar;15(3):363-368. doi: 10.1016/j.hrthm.2017.10.038. Epub 2017 Oct 26.

    PubMed 29107190

Questions about this trial

What is this clinical trial studying?

A study testing Insertable Cardiac Monitor in people with Persistent Atrial Fibrillation, run by University of Rochester at 4 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 29 Jul 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 4 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 29 Jul 2025). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Atrial Fibrillation (AF) Burden Defined as the Mean Amount of Time Spent in AF Over a Pre-specified Period of Time (Excluding Short AF Episodes of ≤30 Seconds) by the Biotronik ICM (BioMonitor3® or Future Generation of Biotronik ICM). (time frame: Between months 3 and 15 after the ablation procedure (to exclude the first 3 month blanking period)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04190186, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Jul 2025.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in