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RECRUITING Phase 2 ClinicalTrials.gov

Finerenone After Catheter Ablation to Reduce Atrial Fibrillation Recurrence

Sponsor: National Cheng-Kung University Hospital • ClinicalTrials.gov ID: NCT07799519

Registry updated: 2026-09-02
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Description

Atrial fibrillation (AF) is a common heart rhythm disorder associated with stroke, heart failure, and increased mortality. Catheter ablation with pulmonary vein isolation (PVI) is an effective rhythm-control strategy, but 20-30% of patients experience AF recurrence within one year. Finerenone, a nonsteroidal mineralocorticoid receptor antagonist with anti-inflammatory, antifibrotic, and metabolic effects, was associated with a lower incidence of AF in prior large trials, and preclinical studies suggest it promotes "browning" of adipose tissue and improves epicardial adipose tissue (EAT) characteristics. This single-center, randomized, investigator-blinded pilot trial will enroll 40 patients undergoing first-time catheter ablation for AF. After successful PVI, participants will be randomized 1:1 to receive finerenone or usual care for 12 months. The primary endpoint is AF recurrence (any atrial arrhythmia episode lasting 30 seconds or longer) after a 90-day blanking period, within 12 months post-ablation. Mechanistic endpoints include EAT remodeling assessed by cardiac computed tomography and echocardiography, and circulating uncoupling protein-1 (UCP1) levels as a biomarker of adipose tissue browning. The investigators hypothesize that finerenone will lower AF recurrence after ablation, partly through modulation of EAT function.

Interventions

  • Finerenone (Drug)
    Oral finerenone 10 mg or 20 mg once daily (dose per eGFR, with Week-4 up-titration where applicable based on serum potassium) for 12 months after catheter ablation.

Eligibility criteria

Inclusion Criteria: * Age 18-80 years * Atrial fibrillation scheduled for first-time catheter ablation (pulmonary vein isolation) * Estimated glomerular filtration rate (eGFR) \>=25 mL/min/1.73 m2 * Serum potassium \<=5.0 mmol/L Exclusion Criteria: * History of prior catheter-based or surgical pulmonary vein isolation * Current use of other mineralocorticoid receptor antagonists (MRAs) * Severe renal impairment (eGFR \<25 mL/min/1.73 m2) * Serum potassium \>5.0 mmol/L * Severe liver disease (Child-Pugh class C) * Known hypersensitivity to the investigational drug * Contraindications to the investigational drug, such as concomitant use of strong CYP3A4 inducers (e.g., rifampicin, carbamazepine, phenytoin, phenobarbital) * Active cancer or recent chemotherapy * Women who are pregnant, breastfeeding, or planning to become pregnant during the study period

Conditions

Atrial Fibrillation (AF)

Locations

  • National Cheng Kung University Hospital — Tainan, Taiwan
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Official Source

Data sourced from ClinicalTrials.gov, a service of the U.S. National Institutes of Health.

View Official Record