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Detection of Atrial Fibrillation After Cardiac Surgery (SEARCH-AF)

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ClinicalTrials.gov Identifier: NCT02793895
Recruitment Status : Recruiting
First Posted : June 8, 2016
Last Update Posted : September 5, 2018
Sponsor:
Information provided by (Responsible Party):
St. Michael's Hospital, Toronto

Brief Summary:

The aim of the SEARCH-AF trial is to evaluate a novel diagnostic tool for detecting post-operative atrial fibrillation or flutter (POAF/AFL) in cardiac surgical subjects during the early, sub-acute post-operative period. The population includes cardiac surgical subjects who have either developed or are at risk for developing new onset POAF/AFL and who are at risk for stroke, as determined by their CHA2DS2-VASC (congestive heart failure, hypertension, age ≥75 years (2 points), diabetes mellitus, previous stroke/transient ischemic attack (TIA) (2 points), vascular disease, age 65-74 years, sex class (female)) score. These subjects must not have had a history of AF/AFL before cardiac surgery.

The intervention group will undergo 30 days of continuous cardiac rhythm monitoring with an adhesive, patch-based monitor (Medtronic SEEQ™ mobile cardiac telemetry system). The control group will receive usual care, which does not involve planned cardiac rhythm testing within the first 30 days after study randomization. The primary outcome is documentation of sustained atrial fibrillation or flutter within the first 30 days after randomization. In addition, subjects in both groups will undergo 14 days of continuous cardiac rhythm monitoring with the Medtronic SEEQ™ mobile cardiac telemetry system at 6±1 months after their index cardiac surgery.


Condition or disease Intervention/treatment Phase
Atrial Fibrillation Atrial Flutter C.Surgical Procedure; Cardiac Arrhythmias, Cardiac Device: Medtronic SEEQ™ mobile cardiac telemetry system Other: Usual Care Not Applicable

Detailed Description:

The aim of the SEARCH-AF trial is to evaluate a novel diagnostic tool for detecting post-operative atrial fibrillation or flutter (POAF/AFL) in cardiac surgical subjects during the early, sub-acute post-operative period. Its primary objective is to test whether enhanced cardiac rhythm monitoring with an adhesive, continuous monitor results in higher rates of atrial fibrillation or flutter (AF/AFL) detection at 30 days after randomization for post-cardiac surgical subjects who are at risk for developing post-operative atrial arrhythmias, when compared to usual care.

The study design is an open-label, two-arm randomized controlled trial (RCT) comparing a strategy of enhanced cardiac rhythm monitoring vs. usual care in 396 post-cardiac surgical subjects who are at risk for developing POAF/AFL.

The primary endpoint is the proportion of subjects with a cumulative AF/AFL burden of ≥6 minutes or documentation of AF/AFL by a 12-lead ECG within 30 days after randomization. Clinical endpoints will be adjudicated by an independent committee of physicians.

The study population involves post-cardiac surgical subjects at high risk of stroke, defined as having a CHA2DS2-VASC score of ≥4 or CHA2DS2-VASC of ≥2 with additional risk factors for developing POAF/AFL. These subjects must not have a history of AF/AFL pre-operatively.

Subjects who meet inclusion criteria will be randomized in a 1:1 ratio to one of the following 2 arms: (i) Enhanced cardiac rhythm monitoring (intervention group) or (ii) Usual care (control group). Subjects in the intervention group will receive 30 days of continuous cardiac rhythm monitoring with the Medtronic SEEQ™ mobile cardiac telemetry system. Monitoring will begin on the day of randomization. Subjects in the usual care group will not undergo protocol-mandated cardiac rhythm monitoring during the first 30 days after randomization.

All subjects will have a follow-up visit at 45-52 days after hospital discharge and at 6±1 months after surgery. At 6±1 months, all subjects will undergo 14 days of continuous cardiac rhythm monitoring with the SEEQ™ mobile cardiac telemetry system. A telephone follow-up will be performed for all subjects at 9±1 months after surgery.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 396 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Diagnostic
Official Title: Post-Surgical Enhanced Monitoring for Cardiac Arrhythmias and Atrial Fibrillation (SEARCH-AF): A Randomized Controlled Trial
Actual Study Start Date : February 24, 2017
Estimated Primary Completion Date : December 2019
Estimated Study Completion Date : September 2020

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Enhanced cardiac rhythm monitoring
Subjects in this group will receive 30 days of continuous cardiac rhythm monitoring with an adhesive monitor. Cardiac rhythm monitoring will begin on the day of randomization. The device that will be used is the Medtronic SEEQ™ mobile cardiac telemetry system. At 6+/-1 months, subjects randomized to the intervention group will undergo 14 days of continuous cardiac rhythm monitoring with the SEEQ™ device.
Device: Medtronic SEEQ™ mobile cardiac telemetry system
The SEEQ™ system consists of a wearable sensor which is a single-lead, low-profile, peel-and-stick device applied over the anterior left chest wall of the subject. The wearable patch is designed for one-time use only and cannot be re-applied if removed. Each sensor provides up to 7.5 days of monitoring. Subjects randomized to the intervention group will undergo 30 days of continuous cardiac rhythm monitoring with the SEEQ™ device at the time of randomization. At 6+/-1 months, subjects randomized to the intervention group will undergo 14 days of continuous cardiac rhythm monitoring with the SEEQ™ device.

Active Comparator: Usual care
Subjects randomized to the usual care arm will be discharged from hospital without protocol-mandated continuous cardiac rhythm monitoring. Within the first 30 days after randomization, no protocol-mandated cardiac rhythm assessment will be arranged. At 6+/-1 months, subjects randomized to the usual care group will undergo 14 days of continuous cardiac rhythm monitoring with the SEEQ™ device.
Other: Usual Care
For subjects randomized to the usual care group, no protocol-mandated cardiac rhythm monitoring will be performed. However, subjects in the control group may undergo rhythm monitoring during the study period if their treating physicians deem that there is a clinical indication to so do. At 6+/-1 months, subjects randomized to the usual care group will undergo 14 days of continuous cardiac rhythm monitoring with the SEEQ™ device.




Primary Outcome Measures :
  1. Number of participants with a cumulative atrial fibrillation/flutter (AF/AFL) duration of ≥6 minutes or documentation of AF/AFL by a 12-lead electrocardiogram [ Time Frame: Within 30 days of randomization ]
    The primary endpoint of this trial is documentation of sustained AF/AFL, defined as a cumulative AF/AFL duration of ≥6 minutes or documentation of AF/AFL by a 12-lead ECG within 30 days after randomization. Clinical endpoints will be adjudicated by an independent clinical events committee.


Secondary Outcome Measures :
  1. Number of participants with atrial fibrillation or flutter lasting for ≥24 hours [ Time Frame: (i) Within 30 days of randomization and (ii) At 6±1 months after surgery ]
    This outcome will be measured by a continuous cardiac modality (e.g. Holter, Event monitor, SEEQ™ mobile cardiac telemetry system)

  2. Duration of cumulative atrial fibrillation or flutter burden amongst participants [ Time Frame: During the 14-day cardiac rhythm monitoring period at 6±1 months after surgery ]
    This outcome will be measured by a continuous cardiac rhythm monitoring modality (e.g. Holter, Event monitor, SEEQ™ mobile cardiac telemetry system)

  3. Number of participants who are prescribed with oral anticoagulation for atrial fibrillation or flutter-related stroke prevention [ Time Frame: (i) 45 days after discharge from cardiac surgery; (ii) 6±1 months after surgery; (iii) 9±1 months after cardiac surgery. ]
    This outcome will be collected during study follow-up visits.

  4. Number of days during which the adhesive Medtronic SEEQ™ sensor was worn by participants [ Time Frame: (i) Within 30 days after randomization (intervention group only); (ii) 6±1 months after surgery (all subjects). ]
    This outcome will be collected during study follow-up visits.

  5. Number of participants who prematurely remove the adhesive Medtronic SEEQ™ sensor. [ Time Frame: (i) Within 30 days after randomization (intervention group only); (ii) 6±1 months after surgery (all subjects). ]
    This outcome will be collected during study follow-up visits.

  6. Number of participants with adverse events related to the use of the Medtronic SEEQ™ device. [ Time Frame: (i) Within 30 days after randomization (intervention group only); (ii) 6±1 months after surgery (all subjects). ]
    This outcome will be collected during study follow-up visits.

  7. Number of participants who undergo non-protocol mandated Holter monitoring and/or event recorders. [ Time Frame: Within 30 days after randomization (all subjects). ]
    This outcome will be collected during study follow-up visits.

  8. Hospitalization or emergency room visits. [ Time Frame: Within the first 45 days after hospital discharge from index cardiac surgery. ]
    This outcome will be collected during study follow-up visits.

  9. Major adverse cardiac outcomes. [ Time Frame: Within the first 45 days after hospital discharge from index cardiac surgery. ]
    All-cause death, myocardial infarction, ischemic stroke, non-CNS systemic embolism

  10. Number of participants with bleeding events. [ Time Frame: Within the first 45 days after hospital discharge from index cardiac surgery. ]
    Major bleeding, clinically relevant non-major bleeding, minor bleeding, fatal bleeding



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Male or female age ≥18 years.
  2. Isolated CABG or valve replacement/repair +/- CABG performed at the index surgical procedure.
  3. At elevated risk of stroke and for having POAF/AFL, defined as having a CHA2DS2-VASC (congestive heart failure, hypertension, age ≥75 years (2 points), diabetes mellitus, previous stroke/transient ischemic attack (TIA) (2 points), vascular disease, age 65-74 years, sex class (female)) score of ≥4 or ≥2 with at least 1 of the following risk factors for developing POAF/AFL:

    (i) Chronic obstructive pulmonary disease; (ii) Sleep apnea; (iii) Impaired renal function (defined as creatinine clearance <60 ml/min/1.73m2); (iv) Echocardiographic evidence of at least mild left atrial enlargement (defined as ≥41 mm on M-mode, ≥59 ml or ≥29 mL/m2 on biplane volume assessment from an echocardiogram performed within 12 months of study enrollment); (v) Elevated body mass index (defined as BMI ≥30); (vi) Combined surgery (CABG + valve repair/replacement).

  4. Able to provide written informed consent.

Exclusion Criteria:

  1. Atrial fibrillation or flutter at the time of randomization.
  2. Known previous history of AF/AFL, diagnosed pre-operatively (note: documentation of a history of AF/AFL without accompanying rhythm proof will suffice).
  3. Documentation of continuous AF/AFL for ≥24 hours during the in-hospital stay for the index cardiac surgery.
  4. Subjects who, at the discretion of the treating cardiac surgery team, would be treated and discharged with oral anticoagulation due to POAF/AFL.
  5. Mechanical valve replacement.
  6. Current or anticipated treatment with oral anticoagulation for indications other than AF/AFL.
  7. Hospitalization for ≥10 days (for the index cardiac surgery, with day #0 being the day of surgery).
  8. Planned discharge from hospital with a type IC or III anti-arrhythmic drug.
  9. Having received >5 grams of IV and/or oral amiodarone during hospitalization for the index cardiac surgical procedure.
  10. Women of childbearing potential (WOCBP).
  11. History of percutaneous or surgical left atrial ablation for AF.
  12. Presence of a cardiac implantable electronic device with a functioning atrial lead (pacemaker, implantable cardioverter defibrillator, or cardiac resynchronization device).
  13. Presence of an implantable loop recorder.
  14. History of left atrial appendage ligation, removal, or occlusion.
  15. Subjects with known allergies or hypersensitivities to adhesives or hydrogel.
  16. Inability to provide written informed consent.
  17. Current or anticipated participation in another randomized controlled trial in which the interventional drug or device is known to affect the incidence of the primary or secondary outcomes of this study.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02793895


Contacts
Contact: Andrew CT Ha, MD 416-340-5206 andrew.ha@uhn.ca
Contact: Judith Hall 416-864-6060 ext 7121 hallju@smh.ca

Locations
Canada, Manitoba
St. Boniface General Hospital Not yet recruiting
Winnipeg, Manitoba, Canada, R2H 2A6
Contact: Wendy Janz       wjanz@exchange.hsc.mb.ca   
Principal Investigator: Rohit Singal, MD         
Canada, New Brunswick
Saint John Regional Hospital Not yet recruiting
Saint John, New Brunswick, Canada, E2L 4L2
Contact: Carole Dube       CSResearch@HorizonNB.ca   
Principal Investigator: Craig Brown, MD         
Canada, Ontario
Kingston General Hospital Not yet recruiting
Kingston, Ontario, Canada, K7L 2V7
Contact: Deborah Dumerton Shore       shored@kgh.kari.net   
Principal Investigator: Tarit Saha, MD         
London Health Sciences Centre Not yet recruiting
London, Ontario, Canada, N6A 5W9
Contact: Stephanie Fox       stephanie.fox@lhsc.on.ca   
Principal Investigator: Michael Chu, MD         
Southlake Regional Health Centre Not yet recruiting
Newmarket, Ontario, Canada, L3Y 2P9
Contact: Christi Darby       christi.darby.raconsulting@gmail.com   
Principal Investigator: Kevin Teoh, MD         
University of Ottawa Heart Institute Not yet recruiting
Ottawa, Ontario, Canada, K1Y 4W7
Contact: Jacqueline Fortier       jfortier@ottawaheart.ca   
Principal Investigator: Buu-Khanh Lam, MD         
St. Michael's Hospital Recruiting
Toronto, Ontario, Canada, M5B1W8
Contact: Shira Brodutch       brodutchs@smh.ca   
Principal Investigator: Subodh Verma, MD         
Principal Investigator: Bobby Yanagawa, MD         
University Health Network Not yet recruiting
Toronto, Ontario, Canada, M5G 2C4
Contact: Ann Hill       ann.hill@uhn.ca   
Principal Investigator: Andrew Ha, MD         
Principal Investigator: Terry Yau, MD         
Canada, Quebec
Laval Hopital Not yet recruiting
Quebec City, Quebec, Canada, G1V 4G2
Contact: Hugo Tremblay       hugo.tremblay@criucpq.ulaval.ca   
Principal Investigator: Francois Dagenais, MD         
Sponsors and Collaborators
St. Michael's Hospital, Toronto
Investigators
Principal Investigator: Andrew CT Ha, MD University Health Network, Toronto
Principal Investigator: Atul Verma, MD St. Michael's Hospital and Southlake Regional Health Centre
Principal Investigator: Subodh Verma, MD, PhD St. Michael's Hospital, Toronto

Responsible Party: St. Michael's Hospital, Toronto
ClinicalTrials.gov Identifier: NCT02793895     History of Changes
Other Study ID Numbers: SEARCH-AF-001
First Posted: June 8, 2016    Key Record Dates
Last Update Posted: September 5, 2018
Last Verified: September 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by St. Michael's Hospital, Toronto:
Atrial fibrillation/flutter
Postoperative atrial arrhythmia
Cardiac surgery
Stroke prevention
Oral anticoagulation
Cardiac rhythm monitoring

Additional relevant MeSH terms:
Atrial Fibrillation
Atrial Flutter
Arrhythmias, Cardiac
Heart Diseases
Cardiovascular Diseases
Pathologic Processes