RethinQ Study - Evaluating Pacing in Heart Failure Patients (RethinQ)

February 1, 2019 updated by: Abbott Medical Devices

Resynchronization Therapy in Normal QRS (RethinQ) Clinical Investigation

Patients with heart failure have a pumping action of the ventricles in which one ventricle contracts before the other ventricle. This uncoordinated (unsynchronized) pumping is due to a delay in the stimulation of the left ventricle because of its increased size. Pacing both the right and the left side of the heart (or cardiac resynchronization therapy [CRT]) has been proven to be effective in the treatment of heart failure (HF). Current market-approved devices combine both pacing (CRT) and shocking (implantable cardioverter defibrillator [ICD]) therapy for patients who have severe heart failure and are at risk for developing life-threatening heart rhythms. These devices provide an electrical pacing stimulus to both ventricles and may help the heart contract in a more coordinated way and improve heart failure symptoms.

The investigational portion of this trial involves the implantation of a market-approved CRT implantable cardioverter defibrillator (CRT-D) system in patients who do not meet the current criteria for a CRT implant. In order to receive a CRT-D implant today, patients must have heart failure symptoms, have a weakened heart muscle, and have uncoordinated pumping of the heart. To demonstrate this uncoordinated pumping of the heart, a test (electrocardiogram [ECG]) is done. It is believed that by using a different test (echocardiogram) to measure whether this uncoordinated pumping is present, more patients will be identified that will benefit from CRT-D therapy. This study will look at whether patients identified by using this echocardiogram test show a benefit from having this CRT-D therapy.

Study Overview

Status

Completed

Conditions

Heart Failure

Intervention / Treatment

Device: Cardiac Resynchronization Therapy

Detailed Description

1.0 Problem of Interest

Patients with heart failure have a pumping action of the ventricles in which one ventricle contracts before the other ventricle. This uncoordinated (unsynchronized) pumping is due to a delay in the stimulation of the left ventricle because of its increased size. Pacing both the right and the left side of the heart (or cardiac resynchronization therapy [CRT]) has been proven to be effective in the treatment of heart failure. Current market-approved devices combine both pacing (CRT) and shocking (ICD) therapy for patients who have severe heart failure and are at risk for developing life-threatening heart rhythms. These devices provide an electrical pacing stimulus to both ventricles at the same time and may help the heart contract in a more coordinated way and improve heart failure symptoms.

The investigational portion of this trial involves the implantation of a market-approved CRT implantable cardioverter defibrillator (CRT-D) system in patients who do not meet the current criteria for a CRT implant. In order to receive a CRT-D implant today, patients must have heart failure symptoms, have a weakened heart muscle, and have uncoordinated pumping of the heart. To demonstrate this uncoordinated pumping of the heart, a test (ECG) is done. It is believed that by using a different test (echocardiogram) to measure whether this uncoordinated pumping is present, more patients will be identified that will benefit from CRT-D therapy.

2.0 Study Summary

Testing will be performed to determine if patients are eligible for this study. An EKG (electrical tracing of the heart) will be performed. They will be asked to complete a 6- minute hall walk test that will provide information regarding their ability to exercise and conduct daily activities. An echocardiogram with tissue Doppler imaging (ultrasound of the heart) will be performed to determine how the heart muscle contracts. Results of this echocardiogram will determine if patients are eligible to participate in this study.

The device system that will be implanted consists of a St. Jude Medical CRT-D and three pacing leads (insulted wires that carry electrical energy from the device to the heart). One lead is placed in the upper right chamber of the heart (atrium), a second lead is placed in the lower right chamber of the heart (right ventricle) and the third lead is placed within a vein that runs along the outside of the heart and is positioned at a location near the left lower chamber of the heart (left ventricle).

A randomization visit will occur approximately 14 days after implant. Patients will be randomized (like a flip of a coin) to one of two groups. Each patient will have an equal chance of being randomized to either of the two groups. One group will receive cardiac resynchronization treatment (CRT ON) and the other group will not receive cardiac resynchronization treatment (CRT OFF). Patients in the CRT OFF group can receive cardiac resynchronization treatment at 6 months after randomization if the doctor determines that it is appropriate.

Prior to randomization and programming of the device, the following tests will be completed:

Quality of Life Questionnaire - contains 21 questions that provide information as to how heart failure affects the patient's daily life.
EKG
6-Minute Hall.
Cardiopulmonary Exercise Stress Testing (CPX) - measures the amount of oxygen used by your body while exercising on a treadmill and breathing through a special breathing tube
Echocardiogram

Follow-up visits will occur at 3 and 6 months following randomization and every 6 months thereafter until the end of the study. The tests performed at the randomization visit (Quality of Life Questionnaire, EKG, 6 minute hall walk, CPX and echocardiogram) will be repeated at the 6-month follow-up visit. Additionally, each visit will include a review of the patient's condition and current medications and an evaluation of the CRT-D device.

3.0 How Will the Research Advance Scientific Knowledge and/or Human Health?

It is hoped that by pacing both lower chambers of the heart in these patients that they will feel better. They may be able to do more activities with fewer symptoms. In addition, the information gathered in this study will add to the understanding of treatment options for patients with heart failure.

4.0 What is the Current Standard of Care?

Alternative treatments to the St. Jude Medical CRT-D system (includes the left heart lead) currently available include implantation of a standard ICD system and/or treatment with medications.

Study Type

Interventional

Enrollment (Actual)

250

Phase

Phase 3

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

United States
- Alabama
  - Birmingham, Alabama, United States, 35294
    - University Hospital University of Alabama at Birmingham
- Arizona
  - Scottsdale, Arizona, United States, 85251
    - Arizona Arrhythmia Consultants
- Arkansas
  - Little Rock, Arkansas, United States, 72211
    - Arkansas Heart Hospital
  - Little Rock, Arkansas, United States, 72205
    - Arkansas Cardiology, PA
- California
  - Glendale, California, United States, 91204
    - Glendale Memorial Hospital and Medical Center
  - La Jolla, California, United States, 92037
    - Scripps Green Hospital
  - Sacramento, California, United States, 95819
    - Mercy General Hospital
- Connecticut
  - Hartford, Connecticut, United States, 06105
    - St. Francis Hospital and Medical Center
- Florida
  - Jacksonville, Florida, United States, 32209
    - Shands Jacksonville
  - Orlando, Florida, United States, 32806
    - Orlando Regional Medical Center
- Georgia
  - Atlanta, Georgia, United States, 30306
    - Emory University
- Illinois
  - Chicago, Illinois, United States, 30322
    - Unversity of Chicago
  - Maywood, Illinois, United States, 60153
    - Loyola University Medical Center
- Iowa
  - Des Moines, Iowa, United States, 50314
    - Iowa Heart Center
- Kentucky
  - Lexington, Kentucky, United States, 40503
    - Central Baptist Hospital
- Massachusetts
  - Boston, Massachusetts, United States, 02114
    - Massachusetts General Hospital
  - Springfield, Massachusetts, United States, 01199
    - Baystate Medical Center
- Michigan
  - Detroit, Michigan, United States, 48236
    - St. John Hospital and Medical Center
  - Lansing, Michigan, United States, 48910
    - Ingham Regional Medical Center
- Minnesota
  - Saint Paul, Minnesota, United States, 55102
    - United Hospital
- Nebraska
  - Lincoln, Nebraska, United States, 68526
    - Nebraska Heart Institute
- New Jersey
  - Browns Mills, New Jersey, United States, 08015
    - Deborah Heart and Lung Center
- New York
  - New York, New York, United States, 10029
    - Mount Sinaí Hospital
  - New York, New York, United States, 10021
    - New York Presbyterian Hospital/Cornell University
  - Roslyn, New York, United States, 11576
    - St. Francis Hospital
- Ohio
  - Cleveland, Ohio, United States, 44195
    - Cleveland Clinic Foundation
  - Cleveland, Ohio, United States, 44106
    - University Hospitals of Cleveland
  - Columbus, Ohio, United States, 43210
    - The Ohio State University
  - Elyria, Ohio, United States, 44035
    - Elyria Regional Medical Center
- Pennsylvania
  - Philadelphia, Pennsylvania, United States, 19104
    - Hospital of the University of Pennsylvania
  - Wynnewood, Pennsylvania, United States, 10969
    - Main Line Health Center/Lankenau Hospital
- South Carolina
  - Charleston, South Carolina, United States, 29401
    - Medical University of Southern California
- Tennessee
  - Germantown, Tennessee, United States, 38138
    - Stern Cardiovascular Center
  - Nashville, Tennessee, United States, 37205
    - St. Thomas 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

Ages Eligible for Study

18 years and older (ADULT, OLDER_ADULT)

Accepts Healthy Volunteers

Genders Eligible for Study

All

Description

Inclusion Criteria:

Have an approved indication for implantation of an ICD.
Have advanced HF with a New York Heart Association (NYHA) Classification of III, despite receiving optimal pharmacological therapy.
Have a stable heart failure medical regimen.
Have a left ventricular ejection fraction (LVEF) <= 35%.
Have evidence of mechanical dyssynchrony as measured by echocardiography using tissue Doppler imaging or M-mode.
Have a QRS duration < 130 ms (present in all ECG leads).
Have the ability to complete exercise stress testing and 6-minute hall walk test, with the only limiting factors being related to cardiac fitness.
Have the ability to independently comprehend and complete a quality of life questionnaire.
Have the ability to provide informed consent for study participation and be willing and able to comply with the prescribed follow-up tests and schedule of evaluations.

Exclusion Criteria:

Have a standard bradycardic indication for pacing.
Have been previously treated with CRT.
Have continuous atrial fibrillation [AF] (continuous is defined as AF lasting > 1 month) within 1 year prior to enrollment or have undergone cardioversion for AF in the past month.
Have the ability to walk > 450 meters during the 6-minute walk test.
Have a NYHA Classification of I, II or IV.
Have symptomatic chronic obstructive pulmonary disease (COPD) as it relates to exercise ability.
Have a classification of Status 1 for cardiac transplantation or consideration for transplantation over the next 6 months.
Have had a recent myocardial infarction, unstable angina or cardiac revascularization (percutaneous transluminal coronary angioplasty [PTCA] or coronary artery bypass graft [CABG]) within 40 days of enrollment.
Have had a recent cerebrovascular accident (CVA) or transient ischemic attack (TIA) within 3 months of enrollment.
Have severe musculoskeletal disorder(s).
Pregnant or planning for pregnancy in the next 6 months.
Currently participating in, or have participated in any clinical investigation within the last 30 days (the only exception being that of a registry trial).
Have a life expectancy of less than 6 months.
Less than 18 years of age.

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

Primary Purpose: TREATMENT
Allocation: RANDOMIZED
Interventional Model: PARALLEL
Masking: DOUBLE

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Cardiac resynchronization therapy (CRT) effectiveness will be evaluated in terms of exercise capacity (peak VO2), as measured by cardiopulmonary exercise testing Time Frame: 6 months	6 months
Safety will be evaluated in terms of survival from CRT-D system-related complications. Time Frame: 6 months	6 months

Secondary Outcome Measures

Outcome Measure	Time Frame
Quality of Life Questionnaire Time Frame: 6 months	6 months
New York Heart Association (NYHA) Classification Time Frame: 6 months	6 months

Collaborators and Investigators

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

Sponsor

Abbott Medical Devices

Investigators

Study Chair: John Beshai, MD, University of Chicago

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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

July 1, 2005

Primary Completion (ACTUAL)

July 1, 2007

Study Completion (ACTUAL)