- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05213104
Assessment of Flecainide to Lower the Patent Foramen Ovale Closure Risk of Atrial Arrhythmia or Tachycardia (AFLOAT)
About 30% of ischemic strokes are cryptogenic. Patent Foramen Ovale (PFO) is present in about 25% of the general population. In cryptogenic strokes, PFO has been shown to be overrepresented and recent intervention studies have confirmed that PFO has a causal link with stroke. In patients with recent cryptogenic stroke, these randomized studies have shown at least 50%-reduction of recurrent neurological events after PFO percutaneous closure compared with medical therapy alone. At the The risk of AF reported in these studies in certainly largely underestimated as only symptomatic and recorded episodes of AF have been declared. Patients often report palpitations without a dia gnosis of AF made on the ECG or a Holter. Long term ECG monitoring provides more accurate data on AF incidence.
Administration of flecainide has been shown to be effective in preventing Atrial arrhythmia and may be useful in preventing these Atrial arrhythmia(AA) episodes after PFO closure.
To the knowledge of the investigators, there is no study assessing the efficacy of any antiarrhythmic drug in the prevention of AFafter PFO closure. AFLOAT will be the first randomized study to possibly validate flecainide to prevent Atrial arrhythmia in these patients.
Study Overview
Status
Intervention / Treatment
Detailed Description
AFLOAT is a national, multicenter, randomized, controlled, open-label superiority study with a blind evaluation of all the endpoints (PROBE design).
The interventional phase is followed by an observational phase as long as the patient is implanted with the ICM during when only the data of the device will be collected.
Screening and selection occurs before the procedure of PFO closure and an inform consent form is signed.
During the procedure of PFO closure, a small ICM (CONFIRM RX, ABBOTT) providing a long-term monitoring is implanted to detect all AA episodes.
Immediately after PFO closure, patients are randomly assigned, in a 1:1:1 ratio, in 3 groups : flecainide (150 mg per day in a single sustained-release dose) for 6 months (in addition to standard of care), flecainide (150 mg per day in a single sustained-release dose) for 3 months (in addition to standard Clinical follow-up is conducted during hospitalization, at 3 months (M3) and 6 months (M6-end-of-interventionnal phase) after discharge. A contrast echocardiography is recommended between 1 and 6 months. Telemonitoring provides notifications in case of arrhythmic event.
An observational period in patients who will keep the ICM beyond the 6-month follow-up period. Atrial arrhythmia detection will be continued.
Study Type
Enrollment (Actual)
Phase
- Phase 3
Contacts and Locations
Study Contact
- Name: Giles MONTALESCOT, MD,PhD
- Phone Number: +33 1 42 16 29 18
- Email: gilles.montalescot@aphp.fr
Study Contact Backup
- Name: Delphine Brugier, PhD
- Phone Number: +33 1 42 16 29 18
- Email: delphine.brugier-ext@aphp.fr
Study Locations
-
-
IDF
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Paris, IDF, France, 75013
- Hôpital Pitié Salpêtrière
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- ≥ 18 years of age
- They are candidates for a procedure of PFO closure, whatever the indication (secondary prevention of stroke, platypnoea, decompression illness…). The indication must have been confirmed by a multidisciplinary team as recommended by the Haute Autorité de Santé.
- They are affiliated to Social Security
- They have provided a signed written consent form ICM implantation and randomization will occur only in patients with successful PFO closure without any major complications
Exclusion Criteria:
- History of atrial arrhythmia (paroxysmal, persistent or permanent)
- Electrocardiographic of ventricular pre-excitation or bundle-branch block (QRS >120ms)
- Ischemic heart disease
- Dilated or hypertrophic cardiomyopathy
- A history of heart failure, severe valvular heart disease, left ventricular dysfunction (ejection fraction <50 percent)
- A long QT interval or Brugada syndrome
- The bradycardia-tachycardia syndrome (resting heart rate, ≤50 beats per minute, or repetitive sinoatrial blocks during waking hours)
- Documentation of previous episodes of second or third-degree atrioventricular block
- High heart rate at baseline > 100 bmp
- Renal insufficiency (Glomerular filtration rate estimated by the Cockroft and Gault formula <30ml/min/m2),
- Previous hypokalemia (potassium level <3 mmol per liter)
- Suspected or known pregnancy (woman of childbearing potential must undergo a pregnancy test)
- A known hypersensibility to flecainide or its excipients
- Contemporaneous enrollment in an interventional clinical trial
- Intended use of a prohibited medication
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: group 1 - Flecainide 150 mg 6 months
Flecainide 150 mg 6 months in addition to standard of care
|
Flecainide 150 mg 6 months in addition to standard of care
Other Names:
Flecainide 150 mg 3 months in addition to standard of care
Other Names:
|
Experimental: group 2 - Flecainide 150 mg 3 months
Flecainide 150 mg 3 months in addition to standard of care
|
Flecainide 150 mg 6 months in addition to standard of care
Other Names:
Flecainide 150 mg 3 months in addition to standard of care
Other Names:
|
No Intervention: group 3 - no Flecainide
to receive no additional treatment (standard of care only).
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
percentage of patients with at least one episode of atrial arrythmia
Time Frame: within 3 months after PFO closure
|
percentage of patients with at least one episode of symptomatic or asymptomatic atrial arrhythmia episodes (≥30s) recorded on long-term monitoring with an insertable cardiac monitor (ICM) during the 3 months after PFO closure Atrial arrhythmia is defined as any episode of AF, atrial flutter or atrial tachycardia that lasts 30 seconds or more, in accordance with the 2012 consensus statement from the Heart Rhythm Society and others
|
within 3 months after PFO closure
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
percentage of patients with at least one episode of atrial arrythmia(AA)
Time Frame: between the 3-months and 6-months follow-up visits
|
Percentage of patients with at least one episode of symptomatic or asymptomatic AA (≥30s) recorded on long-term monitoring with ICM between 3 and 6 months after PFO closure
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between the 3-months and 6-months follow-up visits
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
percentage of stroke or TIA
Time Frame: within 6 months after PFO closure
|
Percentage of patients with at least one episode of fatal or non-fatal stroke or Transient Ischemic Attack (TIA) during the 3 and 6 months after PFO closure
|
within 6 months after PFO closure
|
Percentage of non-scheduled practitioner-consultation or hospitalization for any cardiovascular reason
Time Frame: within 6 months after PFO closure
|
Percentage of patients with at least one episode of non-scheduled practitioner-consultation or hospitalization for any cardiovascular reason during the 3 and 6 months after PFO closure
|
within 6 months after PFO closure
|
All-cause mortality
Time Frame: within 6 months after PFO closure
|
All-cause mortality during the 3 and 6 months after PFO closure
|
within 6 months after PFO closure
|
Rate of Flecainide-related adverse events
Time Frame: from the Day 0 (V0) to the 6 months follow-up visit (V2)
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Rate of Flecainide-related adverse events
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from the Day 0 (V0) to the 6 months follow-up visit (V2)
|
percentage of patients with AA≥6 min
Time Frame: within 3 months after PFO closure
|
Percentage of patients with at least one episode of symptomatic or asymptomatic AA (≥6 min) recorded on long-term monitoring with ICM device during the 3 months after PFO closure
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within 3 months after PFO closure
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Percentage of patients with at least one episode of symptomatic or asymptomatic AA
Time Frame: from Day 0 (V0) till the ICM explantation (up to 2.5 years)
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Percentage of patients with at least one episode of symptomatic or asymptomatic AA episodes (≥6 min) recorded on long-term monitoring with ICM device during the whole follow-up period until battery run out or ICM removal.
|
from Day 0 (V0) till the ICM explantation (up to 2.5 years)
|
Collaborators and Investigators
Collaborators
Investigators
- Study Chair: Giles MONTALESCOT, MD,PhD, Assistance Publique - Hôpitaux de Paris
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Pathologic Processes
- Heart Diseases
- Cardiovascular Diseases
- Vascular Diseases
- Cerebrovascular Disorders
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Congenital Abnormalities
- Cardiac Conduction System Disease
- Stroke
- Heart Defects, Congenital
- Cardiovascular Abnormalities
- Heart Septal Defects, Atrial
- Heart Septal Defects
- Ischemic Stroke
- Arrhythmias, Cardiac
- Tachycardia
- Foramen Ovale, Patent
- Molecular Mechanisms of Pharmacological Action
- Anti-Arrhythmia Agents
- Membrane Transport Modulators
- Voltage-Gated Sodium Channel Blockers
- Sodium Channel Blockers
- Flecainide
Other Study ID Numbers
- APHP201110
- 2021-002608-10 (EudraCT Number)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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