- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06021808
LAA Clipping Versus NOACs to Prevent Stroke in Non-paroxysmal Atrial Fibrillation.
Epicardial Left Atrial Appendage Clipping Versus Novel Oral Anticoagulants to Reduce Stroke Risk in Non-paroxysmal Atrial Fibrillation: a Multicenter Randomized Controlled Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia disease, and the incidence of AF increases markedly with age and approximately doubles with each decade. According to the previous study, the incidence of stroke were five times in patients with AF than those in the general population. Systemic oral anticoagulant is a well-established, guideline-recommended therapy for the prevention of ischemic stroke in patients with nonvalvular AF at high risk of embolism (CHA2DS2-VASc scores ≥2 in men and ≥3 in women), and the guidelines recommend that the novel oral anticoagulants (NOACs) be preferred (Class I, Level of evidence A). However, a significant proportion of patients with nonvalvular AF have difficulties in long-term oral anticoagulant therapy, due to medication adherence and contraindications to oral anticoagulants. Also, several randomized controlled trials indicated that bleeding risk remained high with novel oral anticoagulants. Therefore, it is essential to explore alternative treatment strategies for stroke prevention in patients with nonvalvular AF.
It has been reported that the left atrial appendage (LAA) is suspected as a vital source of cerebral emboli and may lead to ischemic stroke, removal or closure of the LAA may be an alternative to oral anticoagulants. Various surgical or interventional approaches have been developed to close or occlude LAA to prevent stroke in AF patients, such as percutaneous LAA occlusion, suture ligation, and surgical excision. However, these techniques suffer from incomplete LAA closure or the presence of residual blood flow, which can lead to thrombosis and stroke. Thoracoscopic LAA clip, on the other hand, cloud block blood flow between the LAA and the left atrium (LA), achieving isolation of LAA and preventing thrombi and strokes. A previous study has demonstrated a high 95% success rate of LAA clipping without operation-related complications, and freedom from stroke was 99.1% at a median follow-up of 20 months. Therefore, LAA clipping is an effective and durable method in stroke prevention. However, currently high-quality RCTs are lacking to support the superiority of LAA clipping compared with NOACs in terms of stroke prevention and safety. In this trial, the investigators designed a multicenter prospective RCT to compare the efficacy and safety of thoracoscopic LAA clipping and NOACs in patients with non-paroxysmal AF.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Zhe Zheng, MD,PhD
- Phone Number: +86-010-88396051
- Email: zhengzhe@fuwai.com
Study Contact Backup
- Name: Chunyu Yu, MD
- Email: yuchunyu@fuwai.com
Study Locations
-
-
Beijing
-
Beijing, Beijing, China, 100037
- China National Center for Cardiovascular Diseases
-
Contact:
- Chunyu Yu, MD
- Email: yuchunyu@fuwai.com
-
Contact:
- Zhe Zheng, M.D., Ph.D.
- Phone Number: 8610-8839-6051
- Email: zhengzhe@fuwai.com
-
Principal Investigator:
- Zhe Zheng, M.D., Ph.D.
-
Sub-Investigator:
- Chunyu Yu, MD
-
Sub-Investigator:
- Haojie Li, MD
-
Sub-Investigator:
- Chuxiang Lei, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age ≥ 18 years.
- Persistent or long-standing persistent AF documented by medical history or direct electrocardiogram.
- CHA2DS2-VASc ≥2 in men and ≥3 in women.
- Agree to perform thoracoscopic LAA occlusion procedure.
Exclusion Criteria:
- With electrical cardioversion or ablation intent.
- Other heart diseases with surgical indications.
- Ischemic stroke and other cardiac embolic events within 30 days.
- Major clinical bleeding event within 30 days.
- Contraindications to anticoagulation.
- Intracardiac thrombus.
- Left ventricular ejection fraction (LVEF) < 30%.
- Active systemic infection or infective endocarditis or pericarditis
- Severe liver disease (acute clinical hepatitis, chronic active hepatitis, cirrhosis) or alanine transaminase (ALT)/ aspartate transaminase (AST) greater than 3 times the upper limit of normal value.
- Severe renal insufficiency (eGFR ≤ 30mL/min).
- Other diseases requiring oral anticoagulants.
- Active aortic plaque.
- Acute coronary syndrome within 3 months.
- Symptomatic carotid artery stenosis.
- Patients requiring dual antiplatelet drug therapy.
- Previous cardiac and left lung surgery.
- Severe left pleural and pericardial adhesions.
- Pregnant or breastfeeding patients.
- Metal allergies.
- Terminal illness with a life expectancy of less than 2 years.
- Participation in other clinical studies at the time of enrollment.
- Refuse to participate in this study.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: LAA clipping group
In this arm, participants are performed thoracoscopic LAA clipping.
|
The surgeons measured the length of the base of the LAA, an appropriately sized LAA clip is then inserted with the aid of a thoracoscope and placed parallel to the base of the LAA.
|
Active Comparator: NOACs group
Patients randomized to NOAC therapy will begin long-term oral administration of NOACs immediately after enrollment.
|
For patients with creatinine clearance ≥50 ml/min, oral rivaroxaban 20 mg daily was administered, whereas for patients with creatinine clearance between 30-49 ml/min, oral rivaroxaban 15 mg daily was administered.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Rate of composite endpoint
Time Frame: At 24-month after intervention
|
Stroke, systemic embolism, all-cause mortality, major bleeding event, and clinically relevant non-major bleeding event.
|
At 24-month after intervention
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Rate of stroke
Time Frame: At 24-month after intervention
|
Acute episodes of focal or global neurological dysfunction due to cerebral, spinal cord or retinal vascular injury from haemorrhage or infarction.
Symptoms or signs must have lasted ≥ 24 hours, or symptoms/signs may have lasted less than 24 hours if demonstrated by CT, MRI, or autopsy.
|
At 24-month after intervention
|
Rate of systemic embolism
Time Frame: At 24-month after intervention
|
Confirmed by imaging or angiography
|
At 24-month after intervention
|
Rate of all-cause mortality
Time Frame: At 24-month after intervention
|
Deaths from all causes
|
At 24-month after intervention
|
Rate of major bleeding event
Time Frame: At 24-month after intervention
|
|
At 24-month after intervention
|
Rate of clinically relevant non-major bleeding event
Time Frame: At 24-month after intervention
|
Bleeding events that do not meet the criteria for an ISTH major bleeding event but requires hospitalisation or a change in antithrombotic treatment strategy or requires invasive management.
|
At 24-month after intervention
|
Rate of surgery-related complications
Time Frame: At 24-month after intervention
|
Incidence of in-hospital death, in-hospital stroke, intermediate small-incision open thoracotomy or median open thoracotomy, and postoperative re-intervention due to hemorrhage, pneumothorax, and pyothorax.
|
At 24-month after intervention
|
Rate of minor bleeding events
Time Frame: At 24-month after intervention
|
Bleeding events that do not meet the ISTH criteria for a major bleeding event, do not meet the criteria for a clinically relevant non-major bleeding event, and do not require the subject to seek additional assistance from medical care.
|
At 24-month after intervention
|
Collaborators and Investigators
Investigators
- Study Chair: Zhe Zheng, MD,PhD, Fuwai Hospital
Study record dates
Study Major Dates
Study Start (Estimated)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2023-2059
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
product manufactured in and exported from the U.S.
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.
Clinical Trials on Non-paroxysmal Atrial Fibrillation
-
Medtronic Cardiac Rhythm and Heart FailureCompletedParoxysmal Atrial Fibrillation (PAF)United States, Canada
-
Biosense Webster, Inc.Active, not recruitingRefractory Paroxysmal Atrial FibrillationChina
-
Boston Scientific CorporationCompletedParoxysmal Atrial Fibrillation (PAF)United States, Spain, Germany, Australia, United Kingdom, Sweden, Czechia, France, Portugal
-
Biosense Webster, Inc.RecruitingDrug Refractory Paroxysmal Atrial FibrillationUnited States
-
Charite University, Berlin, GermanyGerman Federal Ministry of Education and ResearchTerminatedSymptomatic Paroxysmal Atrial FibrillationGermany
-
Hospital Clinic of BarcelonaCompletedDrug-refractory Paroxysmal Atrial FibrillationSpain
-
Ablacon, Inc.RecruitingAtrial Fibrillation | Arrhythmias, Cardiac | Arrhythmia | Atrial Flutter | Atrial Fibrillation, Persistent | Atrial Tachycardia | Atrial Arrhythmia | Atrial Fibrillation Paroxysmal | Atrial Fibrillation, Paroxysmal or PersistentUnited States, Belgium, Netherlands, Czechia
-
Biosense Webster, Inc.CompletedDrug Refractory Symptomatic Paroxysmal Atrial FibrillationUnited States
-
Abbott Medical DevicesCompletedNon-paroxysmal Atrial Fibrillation | Left Atrial TachycardiaHong Kong, Australia, Italy, Germany, France
-
Medtronic Cardiac Rhythm and Heart FailureMedtronic Atrial Fibrillation SolutionsCompletedSymptomatic Paroxysmal Atrial Fibrillation Without Clinically Significant Heart DiseasesNetherlands, Australia, France, Norway, Germany, Croatia, Italy, Argentina, Belgium
Clinical Trials on Thoracoscopic LAA clipping
-
dr. Muhammad Abdelhafez Mahmoud, MDCompletedHyperhidrosis | Sympathetic Disorder | Children, Adolescents | Thoracoscopic Sympathetic Chain InterruptionEgypt
-
The First Affiliated Hospital with Nanjing Medical...CompletedStroke | Atrial Fibrillation | Systemic EmbolismChina
-
Boston Scientific CorporationWithdrawn
-
University of Sao Paulo General HospitalFundação de Amparo à Pesquisa do Estado de São PauloUnknownCerebral Aneurysm | Brain Aneurysm | Aneurysm, Middle Cerebral Artery | Aneurysm, Anterior Communicating Artery | Aneurysm, Posterior Communicating Artery | Aneurysm, Carotid ArteryBrazil
-
AtriCure, Inc.Completed
-
Montefiore Medical CenterThe Bee FoundationRecruitingAnxiety Depression | Mental Health Wellness 1 | Aneurysm CerebralUnited States
-
Cardia Inc.UnknownNon-Valvular Atrial Fibrillation | Left Atrial AppendageCanada
-
Assiut UniversityNot yet recruiting
-
Abbott Medical DevicesRecruiting
-
University of GiessenCompleted