Left Atrial Appendage Occlusion in Dialysis Patients With Atrial Fibrillation: A Multicentre Pilot Study

Summary

Objectives: This pilot study aims to evaluate the safety and efficacy of left atrial appendage occlusion (LAAO) in dialysis patients and atrial fibrillation (AF) to establish a novel stroke prevention strategy and determine an optimal post-occlusion antithrombotic regime. Page 3 of 50 Hypothesis: The study tests the hypotheses that LAAO is safe for dialysis patients, that a single antiplatelet regimen postprocedure is safe, and that LAAO effectively reduces the composite endpoint of stroke/transient ischemic attack and major bleeding compared to standard care. Instruments: The study employs a multicenter, single-arm prospective registry design. Eligible participants, aged ≥18 with documented AF and ESRF on peritoneal dialysis (PD) or hemodialysis (HD), will undergo LAAO using the Watchman Flx PRO device. Propensity score matched historical cohort from dialysis registry will be identified for comparison.

Main Outcome Measures: The primary endpoint is the composite of stroke/transient ischemic attack/systemic embolism and non-procedural-related major bleeding at one year. Secondary endpoints include individual rates of these events, procedural safety and device occlusion effectiveness. Data Analysis and Expected Results: Statistical analysis will involve descriptive statistics, chi-squared tests, and propensity score matching. A p-value of \<0.05 will be deemed significant. The pilot study anticipates a low peri-procedural complication rate (≤5%) and confirms LAAO's efficacy in stroke and major bleeding reduction in Chinese PD and HD patients compared to standard care. This data will inform the design of a larger randomized controlled trial aimed at validating LAAO as a safe alternative for AF management in dialysis populations.

Conditions

• Dialysis
• Chronic Kidney Disease (Stages 3b-5)
• Atrial Fibrillation
• End Stage Kidney Failure
• Stroke Prevention in Patients With Atrial Fibrillation
• Left Atrial Appendage Occlusion

Sponsors & Collaborators

• The Queen Elizabeth Hospital

  collaborator OTHER

• Pok Oi Hospital

  collaborator OTHER

• Tuen Mun Hospital

  collaborator OTHER_GOV

• Princess Margaret Hospital, Hong Kong

  collaborator OTHER_GOV

• Alice Ho Miu Ling Nethersole Hospital

  collaborator OTHER

• Kiang Wu Hospital

  collaborator OTHER

• Prince of Wales Hospital, Shatin, Hong Kong

  lead OTHER

Principal Investigators

• Kent Chak Yu So, Clinical Assistant Professor · Chinese University of Hong Kong

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2026-01-05

Primary Completion

2028-01-05

Completion

2028-07-05

Countries

• Hong Kong

Study Locations