AzTrials
AzTrials

Left Atrial Appendage ClosureSWISS-APERONCT03399851

Comparison of Amplatzer Amulet and Watchman Device in Patients Undergoing Left Atrial Appendage Closure. (SWISS-APERO)

A study testing Amplatzer Amulet for left atrial appendage closure and Watchman/FLX for left atrial appendage closure in people with Left Atrial Appendage Closure, run by Insel Gruppe AG, University Hospital Bern at 8 sites in 4 countries.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
Search all trials

Trial summary

Left atrial appendage closure (LAAC) is an emerging therapeutic option in non-valvular atrial fibrillation (NVAF) patients with high thromboembolic and bleeding risks. In Europe the devices most frequently utilized for LAAC are Amplatzer Amulet (St. Jude Medical-Abbott) and Watchman (Boston Scientific) system. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Left Atrial Appendage Closure
What is being tested?
Amplatzer Amulet for left atrial appendage closure and Watchman/FLX for left atrial appendage closure
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
200 participants
Where
8 sitesin 4 countries
Study dates
19 Jun 2018to May 2026
Phase
Interventional
Are there results?
None posted in the registry

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

  • Written informed consent
  • Male or female subject aged 18 years or more with no upper age limit and willing to comply with the protocol
  • Indication to a LAAC as indicated in study population (HAS BLEED ≥3 or High bleeding risk as defined by Munich consensus document and CHA2DS2-VASc≥2)

Who cannot join

  • New York Heart Association class IV congestive heart failure
  • Atrial septal defect or atrial septal repair or closure device
  • Single occurrence of atrial fibrillation
  • Cardioversion or ablation procedure planned within 30 days
  • Implanted mechanical valve prosthesis
  • Heart transplantation
Show all 17Show fewer
  • Enrolled in another IDE or IND investigation of a cardiovascular device or an investigational drug
  • Pregnant or pregnancy is planned during the course of the investigation
  • Active infection of any kind
  • Severe chronic kidney insufficiency (CrCl< 30 ml/min)
  • Terminal illness with life expectancy < 1 yr
  • Echocardiographic exclusion criteria
  • Left ventricular ejection fraction < 20%
  • Intra-cardiac thrombus or dense spontaneous echo contrast as visualized by TEE within 2 days before implant
  • Significant mitral valve stenosis (ie, MV <1.5 cm2)
  • Complex aortic atheroma with mobile plaque of the descending aorta and/or aortic arch
  • Cardiac tumor

Trial locations and contacts

8 sites in 4 countries.

8 sites in 4 countries

France4 sites
  • Centre Hospitalier Régional Universitaire Hôpital Jean Minjoz

    Besançon, 25030

  • Hopital cardiologique Haut Lévêque CHU de Bordeaux

    Bordeaux, 33600

  • Hôpital Hôpitaux Universitaires Henri-Mondor

    Créteil, 94010

  • Centre Hospitalier Universitaire Hôpitaux De Rouen

    Rouen, 76000

Other trials in France

Switzerland2 sites
  • Bern University Hospital

    Bern, Switzerland/Bern, 3010

  • Department of Cardiology, Cardiocentro Ticino

    Lugano, 6900

Other trials in Switzerland

Belgium1 site
  • Centre Hospitalier Universitaire de Charleroi

    Charleroi, 6000

Other trials in Belgium

Italy1 site
  • IRCCS Policlinico S.Donato

    Milan, 20097

Other trials in Italy

About this study

Official title: Comparison of Amplatzer Amulet vs Watchman Device in Patients Undergoing Left Atrial Appendage Closure: the SWISS-APERO Randomized Clinical Trial

Left atrial appendage closure (LAAC) is an emerging therapeutic option in non-valvular atrial fibrillation (NVAF) patients with high thromboembolic and bleeding risks. In Europe the devices most frequently utilized for LAAC are Amplatzer Amulet (St. Jude Medical-Abbott) and Watchman (Boston Scientific) system. However there are currently no randomized controlled trials assessing the degree of LAA closure between the two devices. The main purpose of this trial is to evaluate the feasibility and the efficacy of the devices in terms of LAA complete occlusion with a non-invasive imaging technique such as cardiac computed tomography angiography (CCTA).

Read the detailed description

Non-valvular Atrial fibrillation (NVAF) is the most common cardiac arrhythmia and a major cause of morbidity and mortality because of cardioembolic stroke. Oral anticoagulation (OAC) with vitamin K antagonists (VKA) or Non-vitamin K antagonist anticoagulant (NOAC) is the most effective prophylaxis for stroke in NVAF. However (N)OAC therapy is associated with a significant bleeding liability and long-term (N)OAC therapy in patients with NVAF and concomitant high bleeding risk poses safety issues in a sizable and growing population in clinical practice. Thus, a new and emerging therapeutic option in this high-risk patient population is the left atrial appendage closure (LAAC). There are many available systems approved for percutaneous LAAC. One of the most widely used is the Watchman™ system (Boston Scientific), which was tested in the setting of two randomized control trials (RCT), which demonstrated the safety of the procedure and the non-inferiority in terms of stroke reduction compared to OAC. Another device largely used is the Amplatzer Amulet (St. Jude Medical-Abbott). There is no RCT comparing this device with OAC, but many prospective and retrospective studies had shown the same safety profile and the non-inferiority with the OAC. From the very beginning of the LAAC, a crucial assessment is the degree of LAA occlusion granted by the implanted device. Many imaging modalities have been used to assess LAA occlusion, including transesophageal echocardiography (TEE), fluoroscopy or cardiac computed tomography angiography (CCTA). In the setting of available randomized trials, successful closure was defined with the presence of a regurgitant flow ≤ 5 mm assessed with TEE. In the last years several groups assessed the value of CCTA as non-invasive post-procedural surveillance imaging modality after endovascular LAAC to evaluate atrial-side device thrombus, residual leak (and mechanisms thereof), device position, pericardial effusion and most importantly LAA patency. There are currently no randomized controlled trials assessing the degree of LAA occlusion between Amulet and Watchman.

Being tested
Amplatzer Amulet for left atrial appendage closure, Watchman/FLX for left atrial appendage closure

What participants receive

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

  • Amplatzer Amulet for left atrial appendage closureDevice

    The closure of the left atrial appendage (LAAC) is performed percutaneously. Implantation of the Amplatzer Amulet will be performed according to device specific instruction for use, based on both TEE guidance and angiography, femoral venous access and inter-atrial septum crossing.

  • Watchman/FLX for left atrial appendage closureDevice

    The closure of the left atrial appendage (LAAC) is performed percutaneously. Implantation of the Watchman/FLX will be performed according to device specific instruction for use, based on both TEE guidance and angiography, femoral venous access and inter-atrial septum crossing.

Study groups in NCT03399851
Study groupRoleWhat they receive
Amplatzer AmuletActive comparatorLeft atrial appendage closure (LAAC) with Amplatzer Amulet implantation will be performed according to device specific instruction for use, based on both TEE guidance and angiography, femoral venous access and inter-atrial septum crossing.
Receives: Device: Amplatzer Amulet for left atrial appendage closure
Watchman/FLXActive comparatorLeft atrial appendage closure (LAAC) with Watchman/FLX implantation will be performed according to device specific instruction for use, based on both TEE guidance and angiography, femoral venous access and inter-atrial septum crossing.
Receives: Device: Watchman/FLX for left atrial appendage closure

What is being measured

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

  1. Composite of left atrial appendage (LAA) patency at 45 day evaluated with cardiac computed tomography angiography (CCTA) or the crossover from one device to the other device based on morphological/anatomical considerations during device implantation

    Composite endpoint

    Measured: 45 days

Secondary outcomes (15)
  1. All cause of death, stroke, systemic or pulmonary embolism and spontaneous myocardial infarction

    Composite endpoint

    Measured: 48 hours, 45 days, 1 year, 2 years, 3 years, 4 years and 5 years

  2. LAA patency at 45-day and 13-month CCTA in the per protocol and as treated populations

    LAA patency (arterial and/or venous phase) at 45-day and 13-month CCTA in the per protocol and as treated populations

    Measured: 45 days and 13 months

  3. Cardiovascular death

    Cardiovascular death

    Measured: 48 hours, 45 days, 1 year, 2 years, 3 years, 4 years and 5 years

  4. Ischemic stroke

    Ischemic stroke

    Measured: 48 hours, 45 days, 1 year, 2 years, 3 years, 4 years and 5 years

  5. Haemorrhagic stroke

    Haemorrhagic stroke

    Measured: 48 hours, 45 days, 1 year, 2 years, 3 years, 4 years and 5 years

  6. Bleeding events according to the BARC classification at each follow up

    Bleeding events according to the BARC classification at each follow up

    Measured: 48 hours, 45 days, 1 year, 2 years, 3 years, 4 years and 5 years

  7. Procedure-related complications

    Procedure-related complications

    Measured: 48 hours, 45 days, 1 year, 2 years, 3 years, 4 years and 5 years

  8. Rate of patients on (N)OAC at 45 days and 6 months

    Rate of patients on (N)OAC at 45 days and 6 months

    Measured: 45 days and 6 months

  9. Device thrombosis

    Device related thrombosis at 45 day TEE/CCTA and 13-month CCTA in the per protocol and as treated populations

    Measured: 45 days and 13 months

  10. Number of device implantation attempts

    Number of device implantation attempts

    Measured: end of procedure

  11. Total time procedure

    Total time procedure (minutes)

    Measured: end of procedure

  12. x-ray dose

    x-ray dose (cGy.cm2)

    Measured: end of procedure

  13. fluoroscopy duration

    fluoroscopy duration (minutes)

    Measured: end of procedure

  14. amount of contrast used during the procedure

    amount of contrast used during the procedure (ml)

    Measured: end of procedure

  15. LAA patency

    LAA patency at 45 day by TEE in the per protocol and as treated populations

    Measured: 45 days

Timeline

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

  1. First posted16 Jan 2018
  2. Study start19 Jun 2018
  3. Primary completion9 Jul 2021
  4. Study completionMay 2026 (estimated)

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
Single blind
Who is masked
Outcomes assessor
Enrolment
200 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03399851
Sponsor's protocol ID
SWISS-APERO
Acronym
SWISS-APERO
Status last verified
May 2024
First submitted
8 Jan 2018
Last updated
23 May 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Galea R, De Marco F, Aminian A, Meneveau N, Anselme F, Grani C, Huber AT, Teiger E, Iriart X, Angelillis M, Brugger N, Spirito A, Corpataux N, Franzone A, Vranckx P, Fischer U, Pedrazzini G, Bedogni F, Windecker S, Raber L, Valgimigli M. Design and Rationale of the Swiss-Apero Randomized Clinical Trial: Comparison of Amplatzer Amulet vs Watchman Device in Patients Undergoing Left Atrial Appendage Closure. J Cardiovasc Transl Res. 2021 Oct;14(5):930-940. doi: 10.1007/s12265-020-10095-4. Epub 2021 Apr 21.

    PubMed 33884564
  • Galea R, De Marco F, Meneveau N, Aminian A, Anselme F, Grani C, Huber AT, Teiger E, Iriart X, Babongo Bosombo F, Heg D, Franzone A, Vranckx P, Fischer U, Pedrazzini G, Bedogni F, Raber L, Valgimigli M. Amulet or Watchman Device for Percutaneous Left Atrial Appendage Closure: Primary Results of the SWISS-APERO Randomized Clinical Trial. Circulation. 2022 Mar 8;145(10):724-738. doi: 10.1161/CIRCULATIONAHA.121.057859. Epub 2021 Nov 6.

    PubMed 34747186
  • Galea R, Perich Krsnik J, Peters AA, De Marco F, Aminian A, Meneveau N, Heg D, Grani C, Anselme F, Franzone A, Vranckx P, Fischer U, Bedogni F, Raber L, Valgimigli M. Incidence and predictors of persistent left atrial appendage patency and its subtypes after percutaneous closure: a pre-specified analysis of the SWISS-APERO trial. Eur Heart J Cardiovasc Imaging. 2025 Oct 30;26(11):1795-1803. doi: 10.1093/ehjci/jeaf232.

    PubMed 40795219
  • Galea R, De Marco F, Aminian A, Meneveau N, Chalkou K, Anselme F, Grani C, Franzone A, Vranckx P, Fischer U, Valgimigli M, Raber L. 3-Year Clinical Outcomes Comparing the Amulet vs Watchman FLX for Left Atrial Appendage Closure in Patients With Atrial Fibrillation: Results From the SWISS-APERO Randomized Clinical Trial. J Am Coll Cardiol. 2025 Jul 8;86(1):3-14. doi: 10.1016/j.jacc.2025.03.535.

    PubMed 40602941
  • Galea R, Meneveau N, De Marco F, Aminian A, Heg D, Chalkou K, Grani C, Anselme F, Franzone A, Vranckx P, Fischer U, Bedogni F, Raber L, Valgimigli M. One-Year Outcomes After Amulet or Watchman Device for Percutaneous Left Atrial Appendage Closure: A Prespecified Analysis of the SWISS-APERO Randomized Clinical Trial. Circulation. 2024 Feb 6;149(6):484-486. doi: 10.1161/CIRCULATIONAHA.123.067599. Epub 2023 Oct 24. No abstract available.

    PubMed 37875064
  • Galea R, Aminian A, Meneveau N, De Marco F, Heg D, Anselme F, Grani C, Huber AT, Teiger E, Iriart X, Franzone A, Vranckx P, Fischer U, Pedrazzini G, Bedogni F, Valgimigli M, Raber L. Impact of Preprocedural Computed Tomography on Left Atrial Appendage Closure Success: A Swiss-Apero Trial Subanalysis. JACC Cardiovasc Interv. 2023 Jun 12;16(11):1332-1343. doi: 10.1016/j.jcin.2023.02.027. Epub 2023 May 3.

    PubMed 37316145

Questions about this trial

What is this clinical trial studying?

A study testing Amplatzer Amulet for left atrial appendage closure and Watchman/FLX for left atrial appendage closure in people with Left Atrial Appendage Closure, run by Insel Gruppe AG, University Hospital Bern at 8 sites in 4 countries.

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 17 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: status not confirmed, as of the sponsor's last update on 23 May 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 8 sites in France, Switzerland, Belgium, Italy. 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?

Results are not available in the source record.

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?

Composite of left atrial appendage (LAA) patency at 45 day evaluated with cardiac computed tomography angiography (CCTA) or the crossover from one device to the other device based on morphological/anatomical considerations during device implantation (time frame: 45 days). 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 NCT03399851, which also lists 6 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 23 May 2024.

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