AzTrials
AzTrials

Left Atrail Appendage Closure: Peri-device LeaksNCT05131308

Multimodality Evaluation of LAA Leaks Arising After Incomplete LAAC: Insights From the LAA-Leak Registry

An observational study of Left Atrail Appendage Closure: Peri-device Leaks, run by Kansas City Heart Rhythm Research Foundation at 1 site 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

Closure of peri-device leaks (PDL) after incomplete LAAC have shown early feasibility, however no comparison study of all the leak closure modalities exists. Therefore, this is an attempt to report the first 3-way observational comparison study to date, with results in 160 total patients in 3 arms including detachable… Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
leak closure with either detachable embolization coils, vascular plugs/CSO, or RFA
How many people
160 participants
Where
1 siteUnited States
Study dates
11 Jan 2015to 8 Jun 2021
Phase
Observational
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
  • Adult, Older adult

Study population: All patients at risk for stroke or thromboembolism that demonstrated any degree of the significant leak on follow up TEE imaging at least 4-6 weeks following either epicardial, endocardial, or surgical LAAC were included in this study population. All patients were evaluated and followed with imaging, and per investigators' respective clinical judgement, then proceeded to have an intervention for leak closure with either detachable embolization coils, vascular plugs/CSO, or RFA.

Who may be able to join

  • Patients at risk for stroke or thromboembolism that demonstrated any degree of the significant leak on follow up TEE imaging at least 4-6 weeks following either epicardial, endocardial, or surgical LAAC
  • Patients undergoing any form of eccentric or centric/central leak closure with available modalities (detachable embolization coils, vascular plus/septal/ASD occluders, or RF Ablation). Criteria for this was made based on the judgement of the operator, with no specific cutoffs for leak size, follow-up time from LAAC to leak closure, etc)
  • Age greater than 18 years

Who cannot join

  • Patients not undergoing leak closure after incomplete LAAC
  • Patients unable to complete 45 day follow-up imaging for reevaluation of LAA leak
  • Patients unable to consent

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Kansas City Heart Rhythm Institute

    Overland Park, Kansas, 66211

Other trials in United States

About this study

Official title: Comparison of the Efficacy of Successful Leak Closure Between Available Leak Closure Methods for Clinically Relevant and Persisting Leaks Arising After Incomplete LAAC: Insights From the LAA-Leak Registry

Closure of peri-device leaks (PDL) after incomplete LAAC have shown early feasibility, however no comparison study of all the leak closure modalities exists. Therefore, this is an attempt to report the first 3-way observational comparison study to date, with results in 160 total patients in 3 arms including detachable embolization coils, vascular plugs/septal occluders and Radiofrequency ablation.

Read the detailed description

Left Atrial Appendage (LAA) Closure (LAAC) is a potent technique of LAA isolation and exclusion for stroke prevention in patients with atrial fibrillation, with evidence from the PROTECT-AF and PREVAIL-AF trials, including their 5-year follow-up assessments, solidifying LAAC as a viable option in these patients with comparable stroke reduction in comparison to oral anticoagulation (OAC) as well as a reduction in bleeding risk, hemorrhagic CVA, and mortality. However, the surge in the multiple methods of LAA exclusion has also brought to attention postprocedural complications specific to LAAC, namely, peri-device leaks (PDL). The stroke implication and classification of PDL itself still lacks consensus, with an increased thromboembolic (TE) potential due to PDL seen in patients with LARIAT and surgical ligation procedures, yet no statistically significant relationship seen in percutaneous and endocardial LAA closure approaches. PDL > 5mm has been widely accepted as clinically significant, although there remains limited data with no current established guidelines. Placement of a septal occluder device such as Amplatzer Vascular Plug, Detachable embolization coils, Gore Cardioform Septal Occluder (CSO; W.L. Gore and Associates, Newark DE), and radiofrequency ablation (RFA) have all emerged as options to resolve residual PDL and post-surgical/ligation leaks. However, there exists no head-to-head comparison between these modalities. Given their emergence, this is a proposed a multi-center observational study to further assess and evaluate these three treatment modalities for their efficacy for leak closure, assessment of pre-, peri- and post-procedural characteristics after leak closure, TE events, and bleeding risk, and complication rates.

Being tested
leak closure with either detachable embolization coils, vascular plugs/CSO, or RFA
Keywords
Left Atrial Appendage Closure, Central or peri-device leaks

What participants receive

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

  • leak closure with either detachable embolization coils, vascular plugs/CSO, or RFAOther

    All patients were evaluated and followed with imaging, and per investigators' respective clinical judgement, then proceeded to have an intervention for leak closure with either detachable embolization coils, vascular plugs/CSO, or RFA.

Study groups in NCT05131308
Study groupRoleWhat they receive
Detachable embolization coils groupPatients who have an intervention for leak closure with detachable embolization coils
Receives: Other: leak closure with either detachable embolization coils, vascular plugs/CSO, or RFA
Vascular plugs/septal occluders groupPatients who have an intervention for leak closure with vascular plugs/CSO
Receives: Other: leak closure with either detachable embolization coils, vascular plugs/CSO, or RFA
RF Ablation groupPatients who have an intervention for leak closure with Radio Frequency Ablation (RFA)
Receives: Other: leak closure with either detachable embolization coils, vascular plugs/CSO, or RFA

What is being measured

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

  1. Size of PDL After Leak Closure Procedure

    Size of leak in mm on TEE after leak closure procedure, immediately at the end of the procedure and at 1 year follow-up

    Measured: Immediate postprocedural and 1 year follow-up

Secondary outcomes (2)
  1. Periprocedural Complications Occurring From Postoperative Day 0 - Day 7

    Periprocedural complications occurring from Postoperative days 0 - 7, including: device-related thrombus, pericardial effusion/pericardial tamponade requiring intervention and CVA.

    Measured: From postoperative day 0 to day 7

  2. Delayed Procedure-related Complications at 1 Year Follow-up

    Secondary Safety Endpoint: Delayed procedure-related complications at 1 year follow-up including device-related thrombus, pericardial effusion/ pericardial tamponade requiring intervention and CVA.

    Measured: 1 year after procedure

Timeline

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

  1. First posted23 Nov 2021
  2. Study start11 Jan 2015
  3. Primary completion14 Mar 2021
  4. Study completion8 Jun 2021

Resources

More details

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

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Retrospective
Enrolment
160 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05131308
Sponsor's protocol ID
KCHRF-LAA Leak Registry-0007
Status last verified
Apr 2024
First submitted
26 Oct 2021
Last updated
19 Sep 2024
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: No plan to share the data

Publications

  • Holmes DR, Reddy VY, Turi ZG, Doshi SK, Sievert H, Buchbinder M, Mullin CM, Sick P; PROTECT AF Investigators. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial. Lancet. 2009 Aug 15;374(9689):534-42. doi: 10.1016/S0140-6736(09)61343-X.

    PubMed 19683639
  • Holmes DR Jr, Kar S, Price MJ, Whisenant B, Sievert H, Doshi SK, Huber K, Reddy VY. Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial. J Am Coll Cardiol. 2014 Jul 8;64(1):1-12. doi: 10.1016/j.jacc.2014.04.029.

    PubMed 24998121
  • Reddy VY, Doshi SK, Kar S, Gibson DN, Price MJ, Huber K, Horton RP, Buchbinder M, Neuzil P, Gordon NT, Holmes DR Jr; PREVAIL and PROTECT AF Investigators. 5-Year Outcomes After Left Atrial Appendage Closure: From the PREVAIL and PROTECT AF Trials. J Am Coll Cardiol. 2017 Dec 19;70(24):2964-2975. doi: 10.1016/j.jacc.2017.10.021. Epub 2017 Nov 4.

    PubMed 29103847
  • Nguyen A, Gallet R, Riant E, Deux JF, Boukantar M, Mouillet G, Dubois-Rande JL, Lellouche N, Teiger E, Lim P, Ternacle J. Peridevice Leak After Left Atrial Appendage Closure: Incidence, Risk Factors, and Clinical Impact. Can J Cardiol. 2019 Apr;35(4):405-412. doi: 10.1016/j.cjca.2018.12.022. Epub 2018 Dec 21.

    PubMed 30935631
  • Sahore A, Della Rocca DG, Anannab A, Mohanty S, Akella K, Murtaza G, Trivedi C, Gianni C, Chen Q, Bassiouny M, Ahmadian-Tehrani A, Macdonald B, Al-Ahmad A, Tarantino N, Cirone D, Horton RP, Romero J, Lakkireddy D, Di Biase L, Natale A. Clinical Implications and Management Strategies for Left Atrial Appendage Leaks. Card Electrophysiol Clin. 2020 Mar;12(1):89-96. doi: 10.1016/j.ccep.2019.11.010.

    PubMed 32067651
  • Albaghdadi, M., et al., Peri-Device Leaks after Percutaneous Left Atrial Appendage Closure: Clinical Significance and Unmet Diagnostic Needs. Structural Heart, 2020. 4(6): p. 475-481

  • Mohanty S, Gianni C, Trivedi C, Gadiyaram V, Della Rocca DG, MacDonald B, Horton R, Al-Ahmad A, Gibson DN, Price M, Krumerman AK, Palma EC, Di Biase L, Lakkireddy D, Natale A. Risk of thromboembolic events after percutaneous left atrial appendage ligation in patients with atrial fibrillation: Long-term results of a multicenter study. Heart Rhythm. 2020 Feb;17(2):175-181. doi: 10.1016/j.hrthm.2019.08.003. Epub 2019 Aug 7.

    PubMed 31400519
  • Aryana A, Singh SK, Singh SM, O'Neill PG, Bowers MR, Allen SL, Lewandowski SL, Vierra EC, d'Avila A. Association between incomplete surgical ligation of left atrial appendage and stroke and systemic embolization. Heart Rhythm. 2015 Jul;12(7):1431-7. doi: 10.1016/j.hrthm.2015.03.028. Epub 2015 May 18.

    PubMed 25998141
  • Turagam MK, Velagapudi P, Kar S, Holmes D, Reddy VY, Refaat MM, Di Biase L, Al-Ahmed A, Chung MK, Lewalter T, Edgerton J, Cox J, Fisher J, Natale A, Lakkireddy DR. Cardiovascular Therapies Targeting Left Atrial Appendage. J Am Coll Cardiol. 2018 Jul 24;72(4):448-463. doi: 10.1016/j.jacc.2018.05.048. Epub 2018 Jun 26.

    PubMed 29954658
  • Jang SJ, Wong SC, Mosadegh B. Leaks after Left Atrial Appendage Closure: Ignored or Neglected? Cardiology. 2021;146(3):384-391. doi: 10.1159/000513901. Epub 2021 Mar 18.

    PubMed 33735867
  • Della Rocca DG, Horton RP, Di Biase L, Bassiouny M, Al-Ahmad A, Mohanty S, Gasperetti A, Natale VN, Trivedi C, Gianni C, Burkhardt JD, Gallinghouse GJ, Hranitzky P, Sanchez JE, Natale A. First Experience of Transcatheter Leak Occlusion With Detachable Coils Following Left Atrial Appendage Closure. JACC Cardiovasc Interv. 2020 Feb 10;13(3):306-319. doi: 10.1016/j.jcin.2019.10.022. Epub 2020 Jan 15.

    PubMed 31954677
  • Della Rocca DG, Horton RP, Tarantino N, Van Niekerk CJ, Trivedi C, Chen Q, Mohanty S, Anannab A, Murtaza G, Akella K, Gianni C, Bassiouny M, Ahmadian-Tehrani A, Al-Ahmad A, Burkhardt JD, Natale VN, Price M, Gallinghouse GJ, Gibson DN, Lakkireddy D, Di Biase L, Natale A. Use of a Novel Septal Occluder Device for Left Atrial Appendage Closure in Patients With Postsurgical and Postlariat Leaks or Anatomies Unsuitable for Conventional Percutaneous Occlusion. Circ Cardiovasc Interv. 2020 Oct;13(10):e009227. doi: 10.1161/CIRCINTERVENTIONS.120.009227. Epub 2020 Sep 18.

    PubMed 32942913

Questions about this trial

What is this clinical trial studying?

An observational study of Left Atrail Appendage Closure: Peri-device Leaks, run by Kansas City Heart Rhythm Research Foundation at 1 site 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 3 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 19 Sep 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site 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 19 Sep 2024). 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?

Size of PDL After Leak Closure Procedure (time frame: Immediate postprocedural and 1 year follow-up). 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 NCT05131308, which also lists 12 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 19 Sep 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