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Chloroquine for Patients With Symptomatic Persistent Atrial Fibrillation: A Prospective Pilot Study

Primary Purpose

Atrial Fibrillation

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Chloroquine Phosphate
Sponsored by
University of South Florida
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Atrial Fibrillation focused on measuring persistent

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Age 18 years and older
  2. History of symptomatic persistent AF Persistent AF - defined as continuous AF that is sustained more than 7 days but less than 12 months. Episodes of AF of ≥ 48 hours duration in which a decision is made to terminate with electrical or pharmacological cardioversion prior to 7 days will also be classified as persistent AF
  3. AF must be documented at least once either by ECG, event monitoring, loop recorder, telemetry, trans-telephonic monitoring, pacemaker or cardiac defibrillator readouts within 24 months prior to enrollment
  4. Currently on anticoagulation therapy as indicated per local guidelines, which is considered optimal for stroke prevention in the opinion of the investigator
  5. Implanted dual chamber pacemaker/ICD capable of monitoring atrial arrhythmias or willingness to wear a 2 weeks event monitor if patient does not have a device capable of monitoring atrial arrhythmias
  6. Signed informed consent

Exclusion Criteria:

  1. Age < 18 years
  2. AF felt to be secondary to an obvious reversible cause such as, but not limited to, acute myocardial infarction, pulmonary embolism, recent surgery, pericarditis, alcohol intoxication, hypoxemia, or thyrotoxicosis
  3. Structural heart disease including patients with artificial heart valves or valvular AF
  4. Obstructive coronary artery disease or history of any myocardial infarction
  5. Ejection fraction < 50% within 1 year of consent
  6. Severe or moderate to severe aortic stenosis, mitral stenosis, aortic regurgitation, or mitral regurgitation per PI discretion
  7. Prolonged QTc of >460 msec on baseline ECG
  8. Contraindications to quinolines
  9. Known allergy or hypersensitivity to Chloroquine
  10. Use of amiodarone 12 months prior to enrollment
  11. History of AF ablation within 30 days prior to enrollment
  12. Renal impairment (eGFR < 30 mL/min/1.73 m2 or Serum Creatinine > 1.25 mg/dL) for subjects over the age of 65
  13. Hepatic disease (ALT/AST 2X the upper normal limit)
  14. History of alcohol abuse and/or drug abuse per PI discretion
  15. Pre-existing auditory damage
  16. History of epilepsy
  17. Women of child-bearing potential (those who have had a menstrual period in the previous 12 months) who:

    • are pregnant or breast-feeding or plan to become pregnant during study or
    • who are not surgically sterile and are not practicing two acceptable methods of birth control, or do not plan to continue practicing two acceptable methods of birth control throughout the study (highly effective methods are listed under section 6.0 Pregnancy)
  18. Current participation in another clinical study
  19. Serious or active medical or psychiatric condition which, in the opinion of the investigator, may interfere with treatment, assessment, or compliance with the protocol
  20. Not able to discontinue medications known to have significant interactions with chloroquine

Sites / Locations

  • University of South FloridaRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Chloroquine Phosphate

Arm Description

Chloroquine Phosphate will be provided at 500 mg dosage strength for oral administration. Patient will be instructed to take 2 tablets per day on the first two days and 1 tablet each day for the next 12 days for a total of 14 days treatment.

Outcomes

Primary Outcome Measures

Proportion of patients with termination of AF

Secondary Outcome Measures

Percentage of AF burden
AF burden reported on pacemaker/ICD interrogation or 2-week Holter reports from baseline and 2 weeks post drug initiation
QT intervals
From baseline, pre-treatment ECG compared to 2 weeks post treatment ECG
Time to AF termination
In days on pacemaker/ICD interrogation or Holter reports obtained at 2 weeks after study drug initiation
Percentages of classifications of rhythms identified
From pacemaker/ICD interrogation or Holter reports obtained at 2 weeks after study drug initiation
PR interval
From baseline, pre-treatment ECG compared to 2 weeks post treatment ECG
QRS duration
From baseline, pre-treatment ECG compared to 2 weeks post treatment ECG

Full Information

First Posted
October 7, 2016
Last Updated
August 15, 2019
Sponsor
University of South Florida
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1. Study Identification

Unique Protocol Identification Number
NCT02932007
Brief Title
Chloroquine for Patients With Symptomatic Persistent Atrial Fibrillation: A Prospective Pilot Study
Official Title
Chloroquine for Patients With Symptomatic Persistent Atrial Fibrillation: A Prospective Pilot Study
Study Type
Interventional

2. Study Status

Record Verification Date
October 2018
Overall Recruitment Status
Recruiting
Study Start Date
March 28, 2017 (Actual)
Primary Completion Date
March 2020 (Anticipated)
Study Completion Date
September 2020 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of South Florida

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The goal of this pilot study is to explore the efficacy of chloroquine in terminating persistent AF and assess its potential role as a pharmacological cardioversion agent for the management of AF.
Detailed Description
This is an open-label, pilot study to explore the efficacy of chloroquine in terminating persistent AF within 2 weeks of drug administration and assess its potential role as a pharmacological cardioversion agent for the management of AF. Subjects will be followed for 2 weeks from the start of drug administration to study drug termination.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Atrial Fibrillation
Keywords
persistent

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
40 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Chloroquine Phosphate
Arm Type
Experimental
Arm Description
Chloroquine Phosphate will be provided at 500 mg dosage strength for oral administration. Patient will be instructed to take 2 tablets per day on the first two days and 1 tablet each day for the next 12 days for a total of 14 days treatment.
Intervention Type
Drug
Intervention Name(s)
Chloroquine Phosphate
Intervention Description
Two tablets of study drug are to be taken on the day of study drug initiation and the next day, followed by one tablet each day for the next 12 days. Study drug to be orally administered and taken with food.
Primary Outcome Measure Information:
Title
Proportion of patients with termination of AF
Time Frame
Within 2 weeks of study drug initiation
Secondary Outcome Measure Information:
Title
Percentage of AF burden
Description
AF burden reported on pacemaker/ICD interrogation or 2-week Holter reports from baseline and 2 weeks post drug initiation
Time Frame
Within 2 weeks of study drug initiation
Title
QT intervals
Description
From baseline, pre-treatment ECG compared to 2 weeks post treatment ECG
Time Frame
Within 2 weeks of study drug initiation
Title
Time to AF termination
Description
In days on pacemaker/ICD interrogation or Holter reports obtained at 2 weeks after study drug initiation
Time Frame
Within 2 weeks of study drug initiation
Title
Percentages of classifications of rhythms identified
Description
From pacemaker/ICD interrogation or Holter reports obtained at 2 weeks after study drug initiation
Time Frame
Within 2 weeks of study drug initiation
Title
PR interval
Description
From baseline, pre-treatment ECG compared to 2 weeks post treatment ECG
Time Frame
Within 2 weeks of study drug initiation
Title
QRS duration
Description
From baseline, pre-treatment ECG compared to 2 weeks post treatment ECG
Time Frame
Within 2 weeks of study drug initiation

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age 18 years and older History of symptomatic persistent AF Persistent AF - defined as continuous AF that is sustained more than 7 days but less than 12 months. Episodes of AF of ≥ 48 hours duration in which a decision is made to terminate with electrical or pharmacological cardioversion prior to 7 days will also be classified as persistent AF AF must be documented at least once either by ECG, event monitoring, loop recorder, telemetry, trans-telephonic monitoring, pacemaker or cardiac defibrillator readouts within 24 months prior to enrollment Currently on anticoagulation therapy as indicated per local guidelines, which is considered optimal for stroke prevention in the opinion of the investigator Implanted dual chamber pacemaker/ICD capable of monitoring atrial arrhythmias or willingness to wear a 2 weeks event monitor if patient does not have a device capable of monitoring atrial arrhythmias Signed informed consent Exclusion Criteria: Age < 18 years AF felt to be secondary to an obvious reversible cause such as, but not limited to, acute myocardial infarction, pulmonary embolism, recent surgery, pericarditis, alcohol intoxication, hypoxemia, or thyrotoxicosis Structural heart disease including patients with artificial heart valves or valvular AF Obstructive coronary artery disease or history of any myocardial infarction Ejection fraction < 50% within 1 year of consent Severe or moderate to severe aortic stenosis, mitral stenosis, aortic regurgitation, or mitral regurgitation per PI discretion Prolonged QTc of >460 msec on baseline ECG Contraindications to quinolines Known allergy or hypersensitivity to Chloroquine Use of amiodarone 12 months prior to enrollment History of AF ablation within 30 days prior to enrollment Renal impairment (eGFR < 30 mL/min/1.73 m2 or Serum Creatinine > 1.25 mg/dL) for subjects over the age of 65 Hepatic disease (ALT/AST 2X the upper normal limit) History of alcohol abuse and/or drug abuse per PI discretion Pre-existing auditory damage History of epilepsy Women of child-bearing potential (those who have had a menstrual period in the previous 12 months) who: are pregnant or breast-feeding or plan to become pregnant during study or who are not surgically sterile and are not practicing two acceptable methods of birth control, or do not plan to continue practicing two acceptable methods of birth control throughout the study (highly effective methods are listed under section 6.0 Pregnancy) Current participation in another clinical study Serious or active medical or psychiatric condition which, in the opinion of the investigator, may interfere with treatment, assessment, or compliance with the protocol Not able to discontinue medications known to have significant interactions with chloroquine
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Thanh Tran, MPH
Phone
813-844-8544
Email
thanhtran@health.usf.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Sami Noujaim, PhD
Phone
813-974-6416
Email
snoujaim@health.usf.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Sami Noujaim, PhD
Organizational Affiliation
University of South Florida
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of South Florida
City
Tampa
State/Province
Florida
ZIP/Postal Code
33606
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Nhi Tran, MS
Phone
813-259-0628
Email
nntran@health.usf.edu
First Name & Middle Initial & Last Name & Degree
Jacob Siddoway
Email
jsiddoway@health.usf.edu
First Name & Middle Initial & Last Name & Degree
Sami Noujaim, PhD
First Name & Middle Initial & Last Name & Degree
Bengt Herweg, MD
First Name & Middle Initial & Last Name & Degree
Dany Sayad, MD

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
26960034
Citation
Nguyen T, Jolly U, Sidhu K, Yee R, Leong-Sit P. Atrial fibrillation management: evaluating rate vs rhythm control. Expert Rev Cardiovasc Ther. 2016 Jun;14(6):713-24. doi: 10.1586/14779072.2016.1164033. Epub 2016 Mar 30.
Results Reference
background
PubMed Identifier
26826133
Citation
Boriani G, Laroche C, Diemberger I, Fantecchi E, Popescu MI, Rasmussen LH, Dan GA, Kalarus Z, Tavazzi L, Maggioni AP, Lip GY. 'Real-world' management and outcomes of patients with paroxysmal vs. non-paroxysmal atrial fibrillation in Europe: the EURObservational Research Programme-Atrial Fibrillation (EORP-AF) General Pilot Registry. Europace. 2016 May;18(5):648-57. doi: 10.1093/europace/euv390. Epub 2016 Jan 29.
Results Reference
result
PubMed Identifier
22467674
Citation
Filgueiras-Rama D, Martins RP, Mironov S, Yamazaki M, Calvo CJ, Ennis SR, Bandaru K, Noujaim SF, Kalifa J, Berenfeld O, Jalife J. Chloroquine terminates stretch-induced atrial fibrillation more effectively than flecainide in the sheep heart. Circ Arrhythm Electrophysiol. 2012 Jun 1;5(3):561-70. doi: 10.1161/CIRCEP.111.966820. Epub 2012 Mar 30.
Results Reference
result
PubMed Identifier
26964092
Citation
Lee YS, Hwang M, Song JS, Li C, Joung B, Sobie EA, Pak HN. The Contribution of Ionic Currents to Rate-Dependent Action Potential Duration and Pattern of Reentry in a Mathematical Model of Human Atrial Fibrillation. PLoS One. 2016 Mar 10;11(3):e0150779. doi: 10.1371/journal.pone.0150779. eCollection 2016.
Results Reference
result
PubMed Identifier
20585026
Citation
Noujaim SF, Stuckey JA, Ponce-Balbuena D, Ferrer-Villada T, Lopez-Izquierdo A, Pandit S, Calvo CJ, Grzeda KR, Berenfeld O, Chapula JA, Jalife J. Specific residues of the cytoplasmic domains of cardiac inward rectifier potassium channels are effective antifibrillatory targets. FASEB J. 2010 Nov;24(11):4302-12. doi: 10.1096/fj.10-163246. Epub 2010 Jun 28.
Results Reference
result
PubMed Identifier
13541664
Citation
BURRELL ZL Jr, MARTINEZ AC. Chloroquine and hydroxychloroquine in the treatment of cardiac arrhythmias. N Engl J Med. 1958 Apr 17;258(16):798-800. doi: 10.1056/NEJM195804172581608. No abstract available.
Results Reference
result
PubMed Identifier
2460205
Citation
Harris L, Downar E, Shaikh NA, Chen T. Antiarrhythmic potential of chloroquine: new use for an old drug. Can J Cardiol. 1988 Sep;4(6):295-300.
Results Reference
result

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Chloroquine for Patients With Symptomatic Persistent Atrial Fibrillation: A Prospective Pilot Study

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