Left Atrial Appendage Closure With Versus Without Pulsed Field Ablation in Atrial Fibrillation Patients With Mild Symptoms and High Stroke Risk

NCT07453940 | Enrolling By Invitation DMC

• 1 other identifier: SRRSH-ER-2026-Research-0108
• Study Type: interventional
• Target: 50
• Locations: 1 country
• Sites: 1

Brief Summary

This study is a prospective, multicenter, single-blinded, randomized controlled trial to investigate whether concomitant left atrial appendage closure (LAAC) and pulsed field ablation (PFA) is more effective than LAAC alone in improving the outcomes in persistent atrial fibrillation (AF) patients with high risk of stroke. Emerging data show that some-especially those with persistent AF, high AF burden, or early atrial re-modelling-have high stroke and heart failure risks. This pilot study aims to assess whether combining LAAC and PFA improves outcomes more than LAAC alone in persistent AF patients at high stroke risk. Fifty participants will be randomly assigned in a 1:1 ratio to the LAAC or LAAC plus PFA group, with group allocation blinded. Baseline assessments included cardiopulmonary exercise testing (CPET), the Atrial Fibrillation Effect on QualiTy-of-life questionnaire (AFEQT) , and brain magnetic resonance imaging (MRI). In the LAAC group, patients will undergo electrical cardioversion followed by LAAC under general anesthesia; if sinus rhythm could not be achieved by the end of procedure, pharmocol cardioversion will be tried to restore it. In the LAAC plus PFA group, pulmonary vein isolation (PVI) and posterior wall isolation (PWI) will be performed using the FARAPULSE system, then LAAC will be done. If sinus rhythm could not be restored after PFA, cardioversion will be performed. Additional ablation is allowed only if a clear arrhythmia mechanism is identified; empirical ablation is prohibited. Follow-up occurs every two months with 7-day Holter monitoring. CPET, AFEQT, and brain MRI will be repeated at 6 months. During the blanking period, antiarrhythmic drugs may be used except amiodarone due to its long half-life. Ablation is not recommended within the first two months. Crossover to ablation is permitted only for patients with documented AF/AFL/AT recurrence and worsened symptoms (AFEQT score drop ≥10 points from baseline). At crossover or redo-ablation, AFEQT, CPET, and brain MRI will be repeated.

Conditions

ATRIAL APPENDAGE CLOSURE for ATRIAL FIBRILLATION; PFA Ablation and LAAC Procedures

Outcome Measures

Primary Outcomes (1)

• Change in peak VO₂ from baseline to 6 months as assessed by CPET

  Change in peak oxygen uptake (peak VO₂) measured by cardiopulmonary exercise testing (CPET) at the 6-month visit compared with baseline.

  6 months

Secondary Outcomes (7)

• The change of AFEQT at 6-month visit compared to baseline.

  6 months

• Symptomatic AF recurrence at 6 month visit after blanking period.

  6 months

• The change in CBF over 6 months.

  6 months

• The incidence of composite clinical events

  6 MONTHS

• AF burden determined by 7 d Holter during the follow-up visits.

  6 MONTHS

Other Outcomes (4)

• Actionable AF recurrence rate at 6 months, defined as occurrence of any cardioversion, ablation or AAD treatment for AF post blanking period.

  6 MONTHS

• The change of Clinical Frailty Scale Health.

  6 MONTHS

• The change of NT-proBNP/BNP at 6 month compared to baseline.

  6 MONTHS

Study Arms (2)

LAAC+PFA group

EXPERIMENTAL

LAAC plus PFA

Procedure: LAAC plus PFA for persistent AF with high risk of stroke

LAAC group

ACTIVE COMPARATOR

LAAC alone

Procedure: LAAC for persistent AF with high risk of stroke

Interventions

LAAC plus PFA for persistent AF with high risk of stroke PROCEDURE

Pulmonary vein isolation (PVI) and posterior wall isolation (PWI) will be performed using the FARAPULSE system, then LAAC will be done. If sinus rhythm could not be restored after PFA, cardioversion will be performed. Additional ablation is allowed only if a clear arrhythmia mechanism is identified; empirical ablation is prohibited.

LAAC+PFA group

LAAC for persistent AF with high risk of stroke PROCEDURE

Patients will undergo electrical cardioversion followed by LAAC under general anesthesia; if sinus rhythm could not be achieved by the end of procedure, pharmocol cardioversion will be tried to restore it.

LAAC group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age ≥ 18 years old.
• Subjects diagnosed with persistent AF with duration more than 3 months.
• Subjects with AFEQT score \>70 .
• Subjects with CHA2DS2-VA score ≥2.
• Subjects who are willing and capable of providing ICF and participating in all testing associated with this study.

You may not qualify if:

• AF that is secondary to electrolyte imbalance, thyroid disease, alcohol, or other reversible/non-cardiac causes.
• Subjects with the history of AF ablation, LAA surgically closed or otherwise excluded or the LAA anatomy does not accommodate a Closure Device.
• Left atrial anteroposterior diameter ≥ 5.5 cm.
• Heart failure with a NYHA III/IV and/or LVEF ≤35% within 3 months prior to the procedure.
• Any of the following events within 90 days of the Consent Date:
• Myocardial infarction, unstable angina or coronary intervention or any cardiac surgery
• Pericarditis or symptomatic pericardial effusion
• Gastrointestinal bleeding
• Stroke, TIA, or intracranial bleeding or any non-neurologic thromboembolic event
• Contraindication to, or unwillingness to use systemic anticoagulation.
• Subjects with contraindications or not tolerate to EP procedure, general anaesthesia, or the tests included in the study, like CPET, MRI.
• Subjects cannot be removed from Class I/III AAD for reasons other than atrial arrhythmia.
• Women of childbearing potential who are pregnant or lactating.
• Renal insufficiency if an eGFR is \< 30 mL/min/1.73 m2, or with any history of renal dialysis or renal transplant.
• Predicted life expectancy is less than 12 months.

Sponsors & Collaborators

• Sir Run Run Shaw Hospital: lead

Study Sites (1)

Sir Run Run Shaw Hospital

Hangzhou, Zhejiang, 310000, China

Location

MeSH Terms

Interventions

Desmoglein 1

Intervention Hierarchy (Ancestors)

Desmogleins; Desmosomal Cadherins; Cadherins; Cell Adhesion Molecules; Membrane Glycoproteins; Glycoproteins; Glycoconjugates; Carbohydrates; Proteins; Amino Acids, Peptides, and Proteins; Membrane Proteins; Antigens, Surface; Antigens; Biological Factors; Autoantigens

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Chair, Cardiac Rhythm Branch, Chinese Society of Biotechnology

Study Record Dates

• First Submitted: January 27, 2026
• First Posted: March 6, 2026
• Study Start: May 7, 2026
• Primary Completion (Estimated): December 15, 2026
• Study Completion (Estimated): January 31, 2027
• Last Updated: July 1, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will not share

Locations

CN (1)