Carvedilol for Prevention of Paroxysmal Atrial Fibrillation
Verified August 2016 by Dr. Anne M. Gillis, University of Calgary
Heart and Stroke Foundation of Canada
Libin Cardiovascular Institute of Alberta
Information provided by (Responsible Party):
Dr. Anne M. Gillis, University of Calgary
First received: May 28, 2012
Last updated: August 24, 2016
Last verified: August 2016
Atrial fibrillation (AF) is the most common sustained heart rhythm disorder and is associated with significant symptoms and health problems including an increased risk of stroke and death. Current drug therapies are often ineffective and associated with significant side effects. Abnormalities of calcium regulation in cells may lead to triggers for AF. Emerging data suggest that abnormal intracellular calcium regulation mediated through the ryanodine receptor in heart cells may contribute to AF. Recently the investigators have shown that the β-blocker carvedilol which is most commonly used to treat patients with heart failure, modifies calcium regulation mediated through the ryanodine receptor. At present this drug is not frequently used to treat AF. Therefore the investigators will conduct a randomized trial comparing carvedilol to metoprolol for prevention of paroxysmal AF. This may result in improved health and quality of life for people who suffer AF.
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Treatment
||Carvedilol for Prevention of Paroxysmal Atrial Fibrillation
Primary Outcome Measures:
Secondary Outcome Measures:
- number of Emergency room visits/hospitalizations for cardiovascular causes [ Time Frame: 1 year ]
Subjects will be questioned via telephone interview or clinic visit every 3 months and appropriate hospital recorders retrieved for confirmation of event.
- Proportion of patients who develop persistent AF [ Time Frame: 1 year ]
- Days in symptomatic AF/Time between successive PAF episodes [ Time Frame: 1 year ]
The days in which patients report symptomatic AF confirmed by event recorder transmission will be determined and the time interval between successive events will be determined.
- AF Severity Scale [ Time Frame: 1 year ]
Measured via University of Toronto AF Severity Scale at baseline and at end of study or study exit
- Adverse effects of assigned therapy [ Time Frame: 1 year ]
Adverse effects thought to be related to drug therapy will be documented as well as number of patients in whom drug is discontined because of adverse events.
- Ventricular rate during AF [ Time Frame: 1 year ]
Ventricular rate during AF will be measured from the event recorder tracings - from 10 sec of recording
- CCS AF Symptom Score [ Time Frame: 1 yr ]
This will be determined from interview at baseline and each follow-up visit. The CCS AF symptom score is a 5 point score from 0 to 4.
CCS-SAF Class Definitions
Class 0 Asymptomatic with respect to AF Class 1 Symptoms attributable to AF have minimal effect on patient's general QOL.
Class 2 Symptoms attributable to AF have a minor effect on patient's general QOL.
Class 3 Symptoms attributable to AF have a moderate effect on patient's general QOL.
Class 4 Symptoms attributable to AF have a severe effect on patient's general QOL.
| Estimated Enrollment:
| Study Start Date:
| Estimated Study Completion Date:
| Estimated Primary Completion Date:
||June 2017 (Final data collection date for primary outcome measure)
Active Comparator: Metoprolol
The metoprolol arm patients are stratified by the arrhythmia management strategy Rate or Rhythm control and metoprolol is dose titrated from 25 mg bid to a maximum of 50 mg bid over one month then patients are followed for 6 months.
titrated to 50 mg po bid as tolerated over a 1 month period
Other Name: Lopressor
Active Comparator: Carvedilol
The carvedilol arm patients are stratified by the arrhythmia management strategy Rate or Rhythm control and carvedilol is dose titrated from 3.25 mg bid to maximum dose of 25 mg bid over one month then patients are followed for 6 months.
6.25 po bid titrated to 25 mg bid as tolerated over a 1 month period
Other Name: Coreg
The study population will consist of patients with electrocardiographically documented symptomatic paroxysmal AF (≥ 2 episodes of ≥ 15 min duration within a six month period) while on stable antiarrhythmic drug therapy. Patients will be excluded if they have AF due to a reversible cause, persistent AF, significant heart failure or a life expectancy of less than one year. Eligible patients will be randomized to carvedilol or metoprolol and followed for 13 months. Randomization will be stratified based on the AF management strategy (rate or rhythm control). Carvedilol and metoprolol will be initiated over a one month drug titration period to achieve doses of 25mg bid and 50 mg bid respectively. AF occurrence will be documented using event recorders. The co-primary outcome measures are survival free from AF after one month blanking period for drug titration and the number of days in AF detected during follow-up. Secondary outcomes include event free survival to first symptomatic episode of AF, days in symptomatic AF, time between first and second episodes of AF, proportion of patients who develop persistent AF, AF Severity Scale, CCS-AF symptom score, ventricular rate during AF, proportion of patients with discontinuation of the assigned therapy and number of emergency department visits or hospitalizations for cardiovascular causes. Adverse effects and need to discontinue carvedilol or metoprolol will be documented. This study will determine whether carvedilol is safe and effective for prevention of recurrent paroxysmal AF in a general population with AF. Data will be analyzed on an intention to treat basis. Three hundred patients will be recruited over 4 years. The sample size is based on an estimated 20% reduction in event free survival from AF (power 0.90, α = 0.05). Patients will be recruited from our AF clinic population which averages 50 new referrals per month and over 2500 referrals since it's' inception in 2005.
|Ages Eligible for Study:
||18 Years to 90 Years (Adult, Senior)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
- Must be in sinus rhythm at enrollment
- ECG documented symptomatic PAF (> 2 episodes of > 15minutes duration over a 6 month period)
- AF due to reversible causes
- Contraindication or previous significant adverse reaction to Beta blocker therapy
- Persistent AF
- NYHA Class II or greater CHF
- LVEF < or = 35%
- Life expectancy < 1 year
- Geographic isolation
- Unable to give informed consent
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For general information, see Learn About Clinical Studies.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01608893
|University of Calgary
|Calgary, Alberta, Canada, T2N 4Z6 |
|Contact: Anne Gillis |
|Contact: Jennifer McKeage |
|Principal Investigator: Anne M Gillis, M.D. |
|Sub-Investigator: Henry Duff, M.D. |
|Sub-Investigator: Derek Exner, M.D. |
|Sub-Investigator: Katherine Kavanagh, M.D. |
|Sub-Investigator: Vikas Kuriachan, M.D. |
|Sub-Investigator: Brent Mitchell, M.D. |
|Sub-Investigator: Timothy Pollack, M.D. |
|Sub-Investigator: Russell Quinn, M.D. |
|Sub-Investigator: Robert Sheldon, M.D. |
|Sub-Investigator: Glen Sumner, M.D. |
|Sub-Investigator: George Veenhuyzen, M.D. |
|Sub-Investigator: Stephen Wilton, M.D. |
|Sub-Investigator: George Wyse, M.D. |
University of Calgary
Heart and Stroke Foundation of Canada
Libin Cardiovascular Institute of Alberta
||Anne M Gillis, M.D.
||Professor of Medicine
||Dr. Anne M. Gillis, Professor of Medicine, University of Calgary
History of Changes
|Other Study ID Numbers:
Carvedilol for PAF
|Study First Received:
||May 28, 2012
||August 24, 2016
Additional relevant MeSH terms:
ClinicalTrials.gov processed this record on May 25, 2017
Molecular Mechanisms of Pharmacological Action
Physiological Effects of Drugs
Adrenergic alpha-1 Receptor Antagonists
Peripheral Nervous System Agents
Adrenergic beta-1 Receptor Antagonists