Risk Assessment in Patients With Symptomatic- and Asymptomatic Preexcitation (RASAP)

May 21, 2022 updated by: Mats Jensen-Urstad, Karolinska University Hospital
Prospective cohort study including 150 patients with pre-excitation on ECG referred to our clinic for risk assessment. There will be equal numbers of symptomatic and asymptomatic patients included in the study. Each patient will perform an exercise stress test on bicycle before an invasive electrophysiological test. The purpose of this study is to compare exercise stress testing on bicycle to an invasive electrophysiological study, regarding risk assessment of patients with pre-excitation. The electrophysiology study is set as reference.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Hypothesis:

The sensitivity and specificity for exercise stress test (bicycle) is low in identifying patients with benign accessory pathways and cannot replace an invasive electrophysiological study in risk assessment of symptomatic and asymptomatic patients with pre-excitation. Invasive electrophysiological assessment should be recommended for all patients with pre-excitation despite symptoms or documented arrhythmia.

Methods:

Prospective cohort study including 150 patients with pre-excitation on ECG referred to our clinic for risk assessment. There will be equal numbers of symptomatic and asymptomatic patients included in the study. Each patient will perform an exercise stress test on bicycle before an invasive electrophysiological test. The purpose of this study is to compare exercise stress testing on bicycle to an invasive electrophysiological study, regarding risk assessment of patients with pre-excitation. The electrophysiology study is set as reference.

A. Instruments and methods for analysis:

  • All patients will perform an exercise stress test on a test bike according to standard protocol. ECG will be monitored closely regarding loss of pre-excitation during exercise.
  • After exercise testing all patients will undergo an invasive electrophysiological study according to standard protocol.

This procedure is set as reference in identifying potentially dangerous accessory pathways.

  • APERP as well as shortest R-R interval during atrial fibrillation, when applicable, will be used to characterize the conduction properties of the pathway defining high risk pathway with APERP ≤ 250 ms with or without isoprenaline.
  • Inducibility in AVRT (orthodromic or antidromic reentry tachycardia) and atrial fibrillation will be recorded as well as tachycardia cycle length.
  • The results of the two tests will be compared with each patient being their own control.

Programmed stimulation for risk assessment in patients with pre-excitation/accessory pathways:

  1. AV block or block in AP during IAP, ms
  2. VA block or block in AP during IVP, ms
  3. Antegrade curve (single ES 600 ms or longer and 400 ms): APERP And AVNERP
  4. Retrograde curve (single ES 600 ms): Retrograde APERP and AVNERP
  5. Tachycardia induction (Double ES from atrium): Inducibility
  6. Burst pacing from atrium

  7. Isoprenaline: Dose adjustment until heart rate>100/min or >50% increase from basal level.

    • Antegrade curve during isoprenaline: APERP, AVNERP
    • Retrograde curve during Isoprenaline:

Retrograde APERP and AVNERP

- Tachycardia induction during Isoprenaline

Statistical analysis: Sensitivity, specificity, positive predictive value and negative predictive value of exercise stress test will be assessed, using the electrophysiological study as a reference standard. A true positive and a false negative will be defined, respectively, as the persistence and the disappearance of pre-excitation in the symptomatic and asymptomatic group. A true negative and a false positive will be defined, respectively, as the disappearance and the persistence of pre-excitation in the symptomatic and asymptomatic group. Moreover, we will consider the shortest value between the minimum RR interval during atrial fibrillation and accessory pathway anterograde effective refractory period (APERP) in each patient and look for the value that could be predicted by noninvasive tests with the best combination of sensitivity, specificity, positive and negative predictive value.

Chi Square statistics will be used in comparing categorical data such as inducibility and tachycardia cycle length.

B. Calculation of power: With the planned number of patients, 150, a 10% difference should be detected with a power of 80% at α 0,1.

C. Expected results: We expect exercise testing to have high sensitivity, but low specificity and a low positive predictive value.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Observational

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
168

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Sweden
      • Stockholm, Sweden, SE-14186
        • Karolinska University Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

All patients with documented ventricular preexcitation, referred for risk assessment to the Arrhythmia department at Karolinska University Hospital, were asked to participate in the study.

Description

Inclusion Criteria:

  • Ventricular pre exciatation on 12 lead ECG

Exclusion Criteria:

  • Inability to perform invasive electrophysiology testing or exercise stress test on bicycle.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: Cohort
  • Time Perspectives: Prospective

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
RASAP
Time Frame: Approximately 1 year from inclusion to 6 months follow-up.
Number of potentially dangerous pathways (i.e APERP <250 ms) identified by exercise stress test compared to the invasive electrophysiological test in the symptomatic- and asymptomatic Group.
Approximately 1 year from inclusion to 6 months follow-up.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Karolinska University Hospital

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Mats Jensen-Urstad, Professor, Karolinska Institutet

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
December 1, 2016

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
January 31, 2022

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
January 31, 2022

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
February 23, 2017

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
September 29, 2017

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
October 4, 2017

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
May 24, 2022

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
May 21, 2022

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
May 1, 2022

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • RASAP

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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