“We have used the AtriClip device for our at-risk patients undergoing open heart surgery since 2008, and it has performed exceptionally well,” said Gerdisch. “With enrollment of this first stroke study patient, we have begun the process of providing atrial fibrillation patients at highest risk the opportunity to eliminate the most common source of Afib-related strokes.”
Patients with Afib are five times more likely to suffer a stroke compared with patients who have a normal heart rhythm. The higher risk of Afib-related stroke is believed to be related to the pooling of blood in a small muscular pouch within the left atria, called the left atrial appendage (LAA). In Afib patients, the LAA has been shown to be the source of more than 90 percent of stroke-causing blood clots, according to experts. During Afib, blood flow out of the LAA is reduced, increasing the likelihood of clot formation. In some cases these clots travel from the heart to the brain blocking the blood supply. Afib-related strokes typically are much more severe and disabling than non-Afib strokes due to the size and location of clots.
Anticoagulant medications reduce the risk of stroke significantly although they carry a risk of severe bleeding. Other patients may be unable to maintain a therapeutic level of anticoagulation in their systems. This study will enroll Afib patients contraindicated to anticoagulation medication and as a result do not have a reasonable alternative available. No LAA closure devices have been approved for stroke prophylaxis in the United States.
“Afib patients who are unable to take anticoagulation present a conundrum for cardiologists,” noted J.D. Graham, M.D., the referring cardiologist for this case. “We need a reliable method to address their embolic risk, and the answer will come from controlled trials like this.”
The Stroke Feasibility Study is being conducted under an Investigational Device Exemption (IDE). The U.S. Food Drug Administration previously cleared the AtriClip LAA Exclusion System for the occlusion of the left atrial appendage, under direct visualization, in conjunction with other open cardiac surgical procedures.
“This study is key to developing Afib solutions that decrease the social and economic burden of atrial fibrillation,” said Mike Carrel, CEO of AtriCure. “We are enthusiastic that our first patient has been enrolled and that we are moving forward with this trial.”
The feasibility study is a prospective, single-arm, multi-center study for AtriClip Left Atrial Appendage Exclusion System delivered via a minimally invasive surgical procedure on a beating heart. Complete exclusion of the LAA is confirmed during the procedure using echo graphic imaging. The study will be conducted at seven leading centers in the United States, enrolling 30 patients.
The study objective is to evaluate the initial safety and efficacy of the AtriClip for stroke prevention in patients with non-valvular atrial fibrillation, in whom long-term oral anticoagulation therapy is medically contraindicated. Pending the completion of this feasibility study, an IDE pivotal trial would be pursued to expand this study where the clinical data will be used to support a future indication for stroke prophylaxis in patients contraindicated to oral anticoagulation therapy.
The AtriClip LAA Exclusion System is indicated for the occlusion of the left atrial appendage, under direct visualization, in conjunction with other open cardiac surgical procedures. AtriCure received FDA 510(k) clearance for the AtriClip device in June 2010 based upon the successful results of the Exclude trial. In this study, complete exclusion of the LAA was confirmed in 98.4 percent of patients at three months post procedure by a computed tomography scan.
Based in West Chester, Ohio, AtriCure designs and develops atrial fibrillation treatment products. AtriCure’s Synergy Ablation System is approved for the treatment of persistent and longstanding persistent forms of Afib in patients undergoing certain open concomitant procedures. Afib affects more than 5.5 million people worldwide.