AzTrials
AzTrials

New Onset Atrial FibrillationPhase 3NCT05169866

Nifekalant Versus Amiodarone in New-Onset Atrial Fibrillation After Cardiac Surgery

A Phase 3 study testing Nifekalant and Amiodarone in people with New Onset Atrial Fibrillation and Complications; Cardiac, Postoperative, run by Beijing Anzhen Hospital at 1 site in China.

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 The sponsor has not verified this record for over two years, so it may be out of date.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

Postoperative atrial fibrillation is a major complication of cardiac surgery, which could lead to high morbidity and mortality, increase duration of hospital stay and increase the cost of treatment. New-onset atrial fibrillation after cardiac surgery is considered as a multifactorial phenomenon. Read more about this study

Who is it for?
Ages 18 to 85 years
What is being tested?
Nifekalant and Amiodarone
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
274 participants
Where
1 siteChina
Study dates
29 May 2022to Jun 2025
Phase
Phase 3
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 to 85 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age ≥18 years old, <85 years old, no gender limit;
  • Postoperative atrial fibrillation in the ICU after cardiac surgery;
  • The duration of atrial fibrillation> 1 minute, and ≤ 48 hours;
  • Hemodynamically stable (no need to increase vasoactive drugs and SBP>90/MAP>60mmHg);
  • After pre-treatment (including: correcting electrolyte disturbances, optimizing volume status, improving oxygenation, controlling body temperature, analgesia and minimizing the use of inotropes and vasopressors), the clinician believes that antiarrhythmic drugs are needed.
  • Obtained the informed consent from the patients or their family members.

Who cannot join

  • Heart transplantation, left heart assist device (LVAD) or extracorporeal membrane oxygenation (ECMO) treatment;
  • History of atrial fibrillation/atrial flutter and a history of paroxysmal supraventricular tachycardia;
  • Radiofrequency ablation;
  • Rheumatic heart disease;
  • Complex congenital heart disease (with more than two coexisting congenital heart defects);
  • Cardiac tumors;
Show all 15Show fewer
  • Transcatheter aortic valve implantation (TAVI), transcatheter mitral valve intervention (TMVI), and transcatheter tricuspid valve intervention (TTVI);
  • Contraindications to amiodarone/nifekalant (PR interval>240ms; 2nd or 3rd degree atrioventricular block (AVB); QT>440ms; familial long QT syndrome; Untreated thyroid disease; AST or ALT>2 times the upper limit; liver cirrhosis; interstitial lung disease);
  • Heart rate (HR) <50 beats/min and/or QRS>140ms without a pacemaker;
  • Received amiodarone or nifekalant within 6 weeks before the operation;
  • Pregnant and lactating female patients;
  • Uncorrected hypokalemia (serum potassium <3.5mmol/L) or hypomagnesemia (whole blood/serum magnesium below the lower limit);
  • Chronic renal failure and/or continuous renal replacement therapy (CRRT);
  • Return to OR during ICU stay or readmission to ICU from Cardiac Surgery ward.
  • Other factors not suitable for participating in this study

Trial locations and contacts

1 site in 1 country.

Xiaotong Hou, MD, PhD contact

+8610 64456631

xt.hou@ccmu.edu.cn

China1 site, 1 recruiting
  • Beijing Anzhen Hospital

    Beijing

    Xiaqiu Tian, phD, 18813019563, tianxiaqiu720@163.com

    Recruiting

Other trials in China

About this study

Official title: A Randomized Active-Controlled Study Comparing Efficacy and Safety of Nifekalant to Amiodarone in New-Onset Atrial Fibrillation After Cardiac Surgery

Postoperative atrial fibrillation is a major complication of cardiac surgery, which could lead to high morbidity and mortality, increase duration of hospital stay and increase the cost of treatment. New-onset atrial fibrillation after cardiac surgery is considered as a multifactorial phenomenon. Amiodarone, the most commonly used drug for cardioversion, is limited in atrial fibrillation after cardiac surgery due to side effects such as hypotension, bradycardia, and extracardiac side effects. Nifekalant is a novel class III antiarrhythmic agent with short onset time. It is a pure potassium channel blocker, which generally does not cause hypotension and bradycardia. There have been several trials that proven efficacy of nifekalant in converting persistent atrial fibrillation. For atrial fibrillation after cardiac surgery, the effectiveness and safety of nifekalant compared to amiodarone have not yet been reported. The investigators plan to perform a clinical trial comparing nifekalant to amiodarone in new-onset atrial fibrillation after cardiac surgery patients with a primary outcome of cardioversion at 4 hours. Secondary outcomes will follow cardioversion at 90 minutes and 24 hours, maintenance time of sinus rhythm within 24 hours, average time to conversion to sinus rhythm, rate of hypotension, length of ICU stay, length of hospital stay and hospital mortality.

Read the detailed description
  1. Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia post cardiac surgery. Estimates suggest that rates of patients experiencing AF after cardiac surgery exceeds 30%. AF has multiple effects on the cardiopulmonary hemodynamics. New-onset atrial fibrillation after cardiac surgery is considered as a multifactorial phenomenon. Its pathogenesis is characterized by inflammation, oxidative stress and autonomic dysfunction. AF after cardiac surgery could lead to high morbidity and mortality, increase duration of hospital stay and increase the cost of treatment. Treatment of AF include rhythm control and rate control. Typical rate control agents are contraindicated due to need of vasoactive requirements. The 2017 EACTS Guidelines on perioperative medication in adult cardiac surgery recommends that in patients with hemodynamically stable postoperative AF, rhythm control is recommended (I, B). Currently, amiodarone is most commonly used drug for rhythm control. It has long onset and cardioversion time. It can also cause side effects such as hypotension, typically requiring escalating doses of vasoactive medications. Other side effects include bradycardia, and extracardiac side effects in lung, liver and thyroid, which limit the clinical application of amiodarone in AF after cardiac surgery. Nifekalant is a novel class III antiarrhythmic agent with short onset time. It is a pure potassium channel blocker, which generally does not cause hypotension and bradycardia. Nifekalant prolongs the action potential duration and effective refractory period of atrial and ventricular myocytes, and prolong the QT interval. There have been several trials that proven efficacy of nifekalant in converting persistent atrial fibrillation. For new-onset AF post cardiac surgery, the effectiveness and safety of nifekalant compared to standard of care amiodarone have not yet been reported.
  2. Research hypothesis: For patients with new-onset atrial fibrillation after cardiac surgery, administration of nifekalant is not inferior to amiodarone in terms of rate of cardioversion to sinus rhythm at 4 hours.
  3. Methods: Patients after cardiac surgery will be recruited from the ICU based on inclusion and exclusion criteria. Patients identified with new-onset atrial fibrillation with a sustained duration of greater than 1 minutes and less than 48 hours will be considered for the study. Patients will be randomized to amiodarone versus nifekalant using a computerized process. The primary outcome is rate of cardioversion at 4 hours. Secondary outcomes include rates of cardioversion at 90 minutes and 24 hours, maintenance time of sinus rhythm within 24 hours, average time to cardioversion to sinus rhythm, rate of hypotension, length of ICU stay, length of hospital stay and hospital mortality.
Being tested
Nifekalant, Amiodarone
Keywords
Nifekalant, Amiodarone, Cardiac Surgery, Postoperative Atrial Fibrillation

What participants receive

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

  • NifekalantDrug

    Also called Nifekalant Hydrochloride

    Patients identified with new-onset atrial fibrillation with a sustained duration of greater than 1 minutes and less than 48 hours will be considered for the study. Patients randomized to nifekalant arm will receive a bolus of 0.3mg/kg IV in the first 5 minutes and a maintenance dose of 0.2-0.4mg/kg/h for 24 hours.

  • AmiodaroneDrug

    Also called Amiodarone Hydrochloride

    Patients identified with new-onset atrial fibrillation with a sustained duration of greater than 1 minutes and less than 48 hours will be considered for the study. Patients randomized to amiodarone arm will receive a bolus of 150mg IV in the first 10 minutes and a maintenance dose of 0.5-1mg/min for 24 hours.

Study groups in NCT05169866
Study groupRoleWhat they receive
Intravenous NifekalantExperimentalPatients randomized to Nifekalant arm will receive a bolus of 0.3mg/kg IV in the first 5 minutes and a maintenance dose of 0.2-0.4mg/kg/h for 24 hours. If the patient has a recurrence of atrial fibrillation, the maintenance dose can be increased (up to 0.8 mg/kg/h) according to the patient's condition, or receive a bolus of 3mg/kg again at 2 hours intervals. Nifekalant is administered for 24 hours unless meeting the criteria for discontinuation.
Receives: Drug: Nifekalant
Intravenous AmiodaroneActive comparatorPatients randomized to an amiodarone arm will receive a bolus of 150mg IV in the first 10 minutes and a maintenance dose of 0.5-1mg/min for 24 hours. If the patient has a recurrence of atrial fibrillation, the dosage can be adjusted according to the patient's condition, but the total dosage administered within 24 hours should not exceed 2g. Amiodarone is administered for 24 hours unless meeting the criteria for discontinuation.
Receives: Drug: Amiodarone

What is being measured

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

  1. Rate of cardioversion at 4 hours

    Rate of cardioversion of new-onset atrial fibrillation at 4 hours. The rate of cardioversion = the number of patients who meet the cardioversion criteria in the group / the total number of patients in the group × 100%.

    Cardioversion criteria is: atrial fibrillation stops at least once during the 24 hours observation period and lasts for more than 1 minute.

    Measured: 4 hours

Secondary outcomes (14)
  1. Rate of cardioversion at 90 minutes

    Rate of cardioversion of new-onset atrial fibrillation at 90minutes. The rate of cardioversion = the number of cases who meet the cardioversion criteria in the group / the total number of cases in the group × 100%.

    Measured: 90 minutes

  2. Rate of cardioversion at 24 hours

    Rate of cardioversion of new-onset atrial fibrillation at 24 hours. The rate of cardioversion = the number of patients who meet the cardioversion criteria in the group / the total number of patients in the group × 100%.

    Measured: 24 hours

  3. Maintenance time of sinus rhythm within 24 hours

    The total duration of sinus rhythm within 24 hours.

    Measured: 24 hours

  4. Average time to AF conversion to sinus rhythm

    Average time from administration of drugs to cardioversion to sinus rhythm.

    Measured: 24 hours

  5. The incidence of hypotension

    "Hypotension" is defined as: SBP <85mmHg for more than 5 minutes or increase of vasoactive drugs. Incidence = number of cases of hypotension / total number of cases in this group × 100%.

    Measured: 24 hours

  6. Vasoactive Inotropic Score (VIS) at 90 minutes, 4 hours, and 24 hours

    VIS= Dopamine (ug/kg/min) + dobutamine (ug/kg/min) + 100×adrenaline (ug/kg/min) + 50×levosimendan (ug/kg/min) + 10× milrinone (ug/kg/min) + 10000× vasopressin (unit/kg/min) + 100×norepinephrine (ug/kg/min).

    Measured: 24 hours

  7. Incidence of severe bradycardia, 3rd degree AVB, severe ventricular arrhythmia

    Severe ventricular arrhythmia: polymorphic/persistent ventricular tachycardia, torsade de pointes (Tdp), ventricular fibrillation. Incidence = number of cases of severe bradycardia, 3rd degree AVB, severe ventricular arrhythmia / total number of cases in this group × 100%.

    Measured: 24 hours

  8. Liver and kidney function within 24 hours

    Indicators of liver function include ALT and AST. Indicator of kidney function is serum creatinine (Scr).

    Measured: 24 hours

  9. Cardiac function

    Indicator of cardiac function is left ventricular ejection fraction (LVEF) assessed with echocardiography.

    Measured: 24 hours

  10. Adverse events

    Adverse medical events that occur after a patient receives a drug, but it does not necessarily have a causal relationship with the treatment.

    Measured: 24 hours

  11. Co-administration of drugs

    Including patients' basic medications and medications co-administrated during research.

    Measured: 24 hours

  12. Length of ICU stay

    Days of patients' stay in ICU

    Measured: up to 6 months

  13. Days of hospital stay

    Days of patients' stay in hospital

    Measured: up to 6 months

  14. Hospital mortality

    Mortality of patients during hospitalization

    Measured: up to 6 months

Timeline

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

  1. First posted27 Dec 2021
  2. Study start29 May 2022
  3. Primary completionMay 2025 (estimated)
  4. Study completionJun 2025 (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 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Participant
Enrolment
274 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05169866
Sponsor's protocol ID
2021-15
Status last verified
May 2024
First submitted
29 Nov 2021
Last updated
3 Jun 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Nifekalant and Amiodarone in people with New Onset Atrial Fibrillation and Complications; Cardiac, Postoperative, run by Beijing Anzhen Hospital at 1 site in China.

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 6 inclusion and 15 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 3 Jun 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 China. 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.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

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?

Contact Xiaotong Hou, MD, PhD (+8610 64456631, xt.hou@ccmu.edu.cn), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Rate of cardioversion at 4 hours (time frame: 4 hours). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 3 Jun 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