Atrial Fibrillation, Stroke
Conditions
Brief summary
The CLAAS® device will be evaluated for safety and efficacy by establishing its performance is non-inferior to the commercially available WATCHMAN® and Amulet™ left atrial appendage closure devices in patients with non-valvular atrial fibrillation. Patients who are eligible for the trial will be randomized to receive either the CLAAS device or the WATCHMAN or Amulet™ devices and will be followed for 5 years after device implant.
Interventions
DEVICECLAAS
CLAAS
DEVICEWATCHMAN left atrial appendage closure device / Amulet left atrial appendage occluder
WATCHMAN left atrial appendage closure device / Amulet left atrial appendage occluder
Sponsors
Conformal Medical, Inc
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Male or non-pregnant female aged ≥18 years 2. Documented non-valvular AF (paroxysmal, persistent, or permanent) 3. High risk of stroke or systemic embolism, defined as CHA2DS2-VASc score of ≥ 3 4. Has an appropriate rationale to seek a non-pharmacologic alternative to long-term oral anticoagulation 5. Deemed by the site investigator to be suitable for short term oral anticoagulation therapy but deemed less favorable for long-term oral anticoagulation therapy. 6. Deemed appropriate for LAA closure by the site investigator and a clinician not a part of the procedural team using a shared decision-making process in accordance with standard of care 7. Able to comply with the protocol-specified medication regimen and follow-up evaluations 8. The subject (or legally authorized representative, where allowed) has been informed of the nature of the study, agrees to its provisions, and has provided written informed consent approved by the appropriate institutional review board (IRB)/Regional Ethics Board (REB)/Ethics Committee (EC).
Exclusion criteria
1. Pregnant or nursing patients and those who plan pregnancy in the period up to one year following the index procedure. Female patients of childbearing potential must have a negative pregnancy test (per site standard test) within 7 days prior to index procedure. 2. Anatomic conditions that would prevent performance of an LAA occlusion procedure (e.g., atrial septal defect (ASD) requiring closure, high-risk patent foramen ovale (PFO) requiring closure, a highly mobile inter-atrial septal aneurysm precluding a safe TSP, presence of a PFO/ASD closure device, history of surgical ASD repair or history of surgical LAAO closure) 3. Atrial fibrillation that is defined by a single occurrence or that is transient or reversible (e.g., secondary thyroid disorders, acute alcohol intoxication, trauma, recent major surgical procedures) 4. A medical condition (other than atrial fibrillation) that mandates long-term oral anticoagulation (e.g., history of unprovoked deep vein thrombosis or pulmonary embolism, or prosthetic mechanical heart valve) 5. History of bleeding diathesis or coagulopathy, or patients in whom antiplatelet and/or anticoagulant therapy is contraindicated 6. Documented active systemic infection 7. Symptomatic carotid artery disease (defined as \>50% stenosis with symptoms of ipsilateral transient or visual TIA evidenced by amaurosis fugax, ipsilateral hemispheric TIAs or ipsilateral stroke); if subject has a history of carotid stent or endarterectomy the subject is eligible if there is \<50% stenosis noted at the site of prior treatment 8. Recent (within 30 days of index procedure) or planned (within 60 days post-procedure) cardiac or major non-cardiac interventional or surgical procedure 9. Recent (within 30 days of index procedure) stroke or transient ischemic attack 10. Recent (within 30 days of index procedure) myocardial infarction 11. Vascular access precluding delivery of implant with catheter-based system 12. Severe heart failure (New York Heart Association Class IV) 13. Prior cardiac transplant, history of mitral valve replacement or transcatheter mitral valve intervention, or any prosthetic mechanical valve implant 14. Renal insufficiency, defined as estimated glomerular filtration rate (eGFR) \<30 mL/min/1.73 m2 (by the Modification of Diet in Renal Disease equation) 15. Platelet count \<75,000 cells/mm3 or \>700,000 cells/mm3, or white blood cell count \<3,000 cells/mm3 16. Known allergy, hypersensitivity or contraindication to aspirin, heparin, or that would preclude any P2Y12 inhibitor therapy, or to device materials (e.g., nickel, titanium), or the subject has contrast sensitivity that cannot be adequately pre-medicated 17. Actively enrolled or plans to enroll in a concurrent clinical study in which the active treatment arm may confound the results of this trial 18. Unable to undergo general anesthesia 19. Known other medical illness or known history of substance abuse that may cause non-compliance with the protocol or protocol-specified medication regimen, confound the data interpretation, or is associated with a life expectancy of less than 5 years 20. A condition which precludes adequate transesophageal echocardiographic assessment Echo
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Procedure-related complications, all-cause death, major bleeding | 12 months | The primary safety endpoint is a composite of 1) major procedure-related complications including a) cardiac perforation, b) pericardial effusion requiring drainage, c) ischemic stroke, d) device embolization, and e) major vascular complications, or 2) major bleeding, or 3) all-cause death |
| Ischemic stroke and systemic embolism | 18 months | The primary effectiveness endpoint is a composite of ischemic stroke and systemic embolism through 18 months. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Procedure-related complications, all-cause death, major bleeding | 5 years | All elements of the Primary Safety Endpoint will be reported descriptively for all subjects through 5 years: a composite of 1) major procedure-related complications including a) cardiac perforation, b) pericardial effusion requiring drainage, c) ischemic stroke, d) device embolization, and e) major vascular complications, or 2) major bleeding, or 3) all-cause death |
| Device Success | Procedure | A secondary performance and efficacy endpoint is Device Success, defined as LAAO device deployed and implanted in correct position |
| Technical success | 45 days | A secondary performance and efficacy endpoint is Technical Success, defined as Device Success, complete closure or peri-device residual leak ≤5 mm in width on TEE, as evaluated by independent imaging core lab without device-related complications \[evaluated post-procedure\]. |
| Procedure success | 7 Days | A secondary performance and efficacy endpoint is Procedure Success, defined as Technical Success without in-hospital major procedure-related complications (excluding minor device embolization) evaluated at hospitalization or at 7 days whichever is first. |
| Embolic Events | 12 Months, 18 Months | A secondary performance and efficacy endpoint is Embolic Events, defined as ischemic stroke as defined by NeuroARC (29) and systemic thromboembolism characterized as any thromboemboli in the arterial system. |
| Closure Success | 12 months | A secondary performance and efficacy endpoint is Closure Success at 12 months based upon each of the following criteria: a) demonstration of peri-device leak \</=5 mm, and b) demonstration of peri-device leak \</=3 mm |
Countries
Czechia, France, Georgia, Germany, United States, Uzbekistan
Contacts
PRINCIPAL_INVESTIGATORWilliam Gray, M.D.
Lankenau Heart Institute
PRINCIPAL_INVESTIGATORShephal Doshi, M.D.
Pacific Heart Institute
Outcome results
None listed