The Iliac Arterio-venous Fistula for Treatment of Neurally Mediated Syncope Study (SHAM-ROX NMS)
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Neurally mediated syncope (NMS) is a debilitating condition, with no proven therapeutic measures. The ROX coupler is a device used to create an Iliac arterio-venous anastamosis which allows a shunt of 0.8 litres per minute. The haemodynamic changes following creation of an arterio-venous anastomosis at the iliac level leads to an increase in cardiac preload, reversing finding thought to induce NMS.
This a randomised controlled study to evaluate the effect of Iliac arterio-venous anastamosis in patients with neurally mediated syncope. The Head up tilt test is used as an objective measure to evaluate the effect of the arterio-venous anastamosis in patients with NMS. Participants with tilt test proven NMS will be eligible for the study ( if they satisfy all other eligibility criteria). Participants will be randomised to ROX coupler intervention or standard therapy. The primary outcome measure will be absence of loss consciousness on tilt table testing at 3 months post intervention.
Study Type
Study Type
Enrollment (Anticipated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Neil Sulke, BSc, DM, FRCP
- Email: neil.sulke@esht.nhs.uk
Study Contact Backup
- Name: Shunmugam Ragunath Shunmugam, MBBS, MRCP
- Email: r.shunmugam@nhs.net
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- ADULT
- OLDER_ADULT
- CHILD
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Absence of transient loss of consciousness associated with reflex bradycardia or hypotension on tilt testing at 3 months following randomised intervention
Exclusion Criteria:
- Time to first episode of syncope after randomised intervention
- Number of syncopal episodes in the first 3 months after randomised intervention.
- Tilt table response at 6 months following randomised intervention i.e. 3 months after unblinding
- Number of syncopal episodes at 6 months after intervention i.e. 3 months after unblinding
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: SINGLE
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
ACTIVE_COMPARATOR: ROX COUPLER
Iliac arterio-venous anastamosis created by insertion of ROX coupler device.
|
ROX coupler device is inserted to create an Iliacartero-venous anastamosis following right heart catheterisation.
|
|
SHAM_COMPARATOR: ROUTINE CARE
Right heart catheterisation and Routine care of Neurally mediated syncope.
|
Participants will have right heart catheterisation followed by routine care.
Participants will be blinded to ROX coupler insertion.
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Absence of loss of consciousness on tilt table testing
Time Frame: 3 months
|
Absence of loss of consciousness associated with reflex bradycardia or hypotension on head up tilt table testing at 3 months post intervention
|
3 months
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Time Frame |
|---|---|
|
Time to first episode of syncope after randomised intervention
Time Frame: 3 months
|
3 months
|
|
Number of syncopal episodes in the first 3 months after randomised intervention
Time Frame: 3 months
|
3 months
|
|
Tilt table response at 6 months following randomised intervention i.e. 3 months after unblinding
Time Frame: 6 months
|
6 months
|
|
Number of syncopal episodes at 6 months after intervention i.e. 3 months after unblinding
Time Frame: 6 months
|
6 months
|
Other Outcome Measures
Other Outcome Measures
Outcome Measure |
Time Frame |
|---|---|
|
Heart rate variability following intervention as observed on 24 hour holter monitoring
Time Frame: 3 and 6 months
|
3 and 6 months
|
|
Changes in echocardiographic parameters following intervention compared to baseline.
Time Frame: 3 and 6months
|
3 and 6months
|
|
Change in exercise capacity assessed by cardio-pulmonary exercise testing after intervention compared to baseline.
Time Frame: 3 and 6months
|
3 and 6months
|
Collaborators and Investigators
Sponsor
Sponsor
Study record dates
Study Major Dates
Study Start
Study Start
Primary Completion (ANTICIPATED)
Primary Completion
Study Completion (ANTICIPATED)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
First Posted
Study Record Updates
Last Update Posted (ESTIMATE)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Cardiovascular Diseases
- Vascular Diseases
- Nervous System Diseases
- Neurologic Manifestations
- Neurobehavioral Manifestations
- Congenital Abnormalities
- Pathological Conditions, Anatomical
- Autonomic Nervous System Diseases
- Cardiovascular Abnormalities
- Unconsciousness
- Consciousness Disorders
- Vascular Malformations
- Primary Dysautonomias
- Orthostatic Intolerance
- Arteriovenous Malformations
- Vascular Fistula
- Fistula
- Syncope
- Syncope, Vasovagal
- Arteriovenous Fistula
Other Study ID Numbers
Other Study ID Numbers
- SHAM-ROX NMS
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