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

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.

NCT Number	NCT07257614
Lead Sponsor	Prince of Wales Hospital, Shatin, Hong Kong Collaborators: The Queen Elizabeth Hospital, Pok Oi Hospital, Tuen Mun Hospital, Princess Margaret Hospital, Hong Kong, Alice Ho Miu Ling Nethersole Hospital, Kiang Wu Hospital
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
Enrollment	40 participants
Start Date	2026-01-05
Primary Completion	2028-01-05 (estimated)
Study Completion	2028-07-05 (estimated)
Updated on ClinicalTrials.gov	2025-12-04