- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01296022
A PRospective, rAndomizEd Comparison of subcuTaneOous and tRansvenous ImplANtable Cardioverter Defibrillator Therapy (PRAETORIAN)
Randomized Trial to Study the Efficacy and Adverse Effects of the Subcutaneous and Transvenous Implantable Cardioverter Defibrillator (ICD) in Patients With a Class I or IIa Indication for ICD Without an Indication for Pacing
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Background of the study: The use of implantable cardioverter defibrillators (ICDs) is an established therapy for the prevention of death from ventricular arrhythmia. Recently a new subcutaneous ICD has been introduced, eliminating the need for transvenous lead placement in or on the heart which is mandatory in the transvenous ICD. The new subcutaneous ICD therapy already proved to be feasible and safe and is an approved therapy in Europe. It is likely that the eliminated need for transvenous lead placement substantially reduces the implantation related complications and elongates lead longevity and thus reduces inappropriate shocks associated with lead fractures. On the other hand it is unclear whether the lack of capability to provide antitachy-pacing (ATP) in the subcutaneous ICD may be a limitation for patients with frequent recurrent ventricular tachycardia. This randomized controlled trial will outline the advantages and disadvantages of the subcutaneous ICD.
Objectives of the study: (1) To compare the subcutaneous ICD to the transvenous ICD for major adverse events (i.e. inappropriate shocks, acute and chronic implant related complications and lead- or device related complications). (2) To determine to which degree the lack of ATP function leads to more appropriate shocks in patients with a subcutaneous ICD.
Study design: Multicenter, prospective, randomized controlled trial with either treatment with the transvenous ICD or subcutaneous ICD (1:1).
Study population: 2x425 patients with class I or IIa indication for ICD therapy without an indication for pacing.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Prague, Czechia
- Na Homolce Hospital
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Copenhagen, Denmark
- Rigshospitalet
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Dresden, Germany
- Herzzentrum Dresden
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Jena, Germany
- Universitätsklinikum Jena
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Kiel, Germany
- Universtätsklinikum Kiel
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Leipzig, Germany
- Herzzentrum Leipzig
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Mannheim, Germany
- Universitätsklinikum Mannheim
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Munich, Germany
- University Hospital Grosshadern
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Wurzburg, Germany
- Universitätsklinikum Würzburg
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Alkmaar, Netherlands
- Noordwest Hospital
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Almere, Netherlands
- Flevoziekenhuis
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Amsterdam, Netherlands
- Onze Lieve Vrouwe Gasthuis
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Amsterdam, Netherlands
- VU Medical Center
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Amsterdam, Netherlands
- Academic Medical Center - University of Amsterdam (AMC-UvA)
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Breda, Netherlands
- Amphia Hospital
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Eindhoven, Netherlands
- Catharina hospital
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Enschede, Netherlands
- Medisch Spectrum Twente
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Leeuwarden, Netherlands
- Medisch Centrum Leeuwarden
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Maastricht, Netherlands
- Maastricht University Medical Center
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Nieuwegein, Netherlands
- St. Antonius Hospital
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Nijmegen, Netherlands
- Radboudumc
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Rotterdam, Netherlands
- ErasmusMC
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Zwolle, Netherlands
- Isala Klinikum Zwolle
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Birmingham, United Kingdom
- Queen Elizabeth Hospital
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Liverpool, United Kingdom
- Heart & Chest Hospital
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London, United Kingdom
- Hammersmith Hospital
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London, United Kingdom
- Saint Bartholomew's Hospital
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London, United Kingdom
- St. Georges Hospital of London
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Oxford, United Kingdom
- Oxford University Hospitals NHS Trust
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Connecticut
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New Haven, Connecticut, United States, 06510
- Yale-New Haven Hospital
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Georgia
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Atlanta, Georgia, United States, 30322
- Emory University Hospital
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Illinois
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Chicago, Illinois, United States, 60611
- Northwestern Memorial Hospital
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Chicago, Illinois, United States, 60637
- The University of Chicago Medicine
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New Jersey
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Englewood, New Jersey, United States, 07631
- Englewood Hospital and Medical Center
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Ridgewood, New Jersey, United States, 07450
- The Valley Hospital
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New York
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New York, New York, United States, 10065
- Weill Cornell Medical College
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New York, New York, United States, 10032
- Columbia University
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New York, New York, United States, 10029
- Mount Sinai Hospital
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Ohio
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Columbus, Ohio, United States, 43210
- Ohio State University Wexner Medical Center
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patients 18 years and older
- Patients with class I or IIa indication for ICD therapy according to the ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death
Exclusion Criteria:
- Patients with documented therapy refractory monomorphic ventricular tachycardia
- Patients having an indication for pacing therapy
- Patients with ventricular tachycardia less than 170 bpm
- Patients failing appropriate QRS/T-wave sensing with the S-ICD ECG patient screening tool provided by Cameron Health/Boston Scientific
- Patients with incessant ventricular tachycardia
- Patients with a serious known concomitant disease with a life expectancy of less than one year
- Patients with circumstances that prevent follow-up (no permanent home or address, transient, etc.)
- Patients who have had a previous ICD implant
- Patient who receive cardiac contractility modulation therapy or are likely to receive cardiac contractility modulation therapy.
- Patients who are unable to give informed consent
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Active Comparator: Subcutaneous ICD
Subcutaneous Implantable Cardioverter Defibrillator
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Implantation of subcutaneous ICD
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Active Comparator: Transvenous ICD
Transvenous Implantable Cardioverter Defibrillator
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Implantation of transvenous ICD
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Number of participants with implantable cardioverter defibrillator (ICD) related adverse events
Time Frame: 48 months
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ICD related adverse events are defined as inappropriate shocks and/or implant-, lead- and device related complications.
An inappropriate shock is shock therapy for anything else but ventricular fibrillation or ventricular tachycardia.
Implant related complications are defined as ICD related infections, ICD related bleedings, thrombotic events, need for lead reposition, post-implant pneumothorax, post-implant hematothorax, or post-implant perforation/tamponade.
Lead- or device related complications are all complications related to the lead or device.
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48 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of Major Adverse Cardiac Event (MACE)
Time Frame: 48 months
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MACE is defined as cardiac death, myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting and/or any valve surgery
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48 months
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Number of appropriate shocks
Time Frame: 48 months
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An appropriate shock is shock therapy for ventricular fibrillation or ventricular tachycardia.
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48 months
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Number of inappropriate shocks
Time Frame: 48 months
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Inappropriate shocks are defined as above.
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48 months
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Number of complications individually
Time Frame: 48 months
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Complications are defined as above.
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48 months
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Quality of life
Time Frame: 30 months
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The quality of life is measured by the SF-36 and Duke Activity Status Index questionnaires.
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30 months
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Time to successful therapy
Time Frame: 48 months
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Time to successful therapy is the time between the start of VT or VF until the first successful shock or first successful ATP episode.
This includes the time of sensing and charging.
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48 months
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First shock conversion efficacy
Time Frame: 48 months
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First shock conversion efficacy is the amount of patients with VT or VF who are successfully converted with the first shock given by the transvenous ICD or subcutaneous ICD.
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48 months
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Implant procedure time
Time Frame: 48 months
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Implant procedure time is the time between the first incision and placement of the last suture (skin-to-skin time).
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48 months
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Hospitalization rate
Time Frame: 48 months
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The hospitalization rate is the number of days a patient is admitted to the hospital associated with ICD implantation.
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48 months
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Fluoroscopy time
Time Frame: 48 months
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Fluoroscopy time is the total time that fluoroscopy is used during the implantation of either the transvenous ICD or subcutaneous ICD.
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48 months
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Cardiac (pre-)syncope events
Time Frame: 48 months
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Cardiac syncope is a loss of consciousness due to cerebral hypoperfusion caused by cardiac arrhythmias or presumed cardiac arrhythmias
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48 months
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Cross-overs to the other arm
Time Frame: 48 months
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A crossover to the other arm is defined as a patient who for any reason after randomization is switched to the other ICD arm
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48 months
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Cardiac decompensation
Time Frame: 48 months
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Cardiac decompensation refers to acute failure of the heart to maintain adequate blood circulation for which hospitalization and medical treatment is necessary.
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48 months
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Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Reinoud E Knops, MD, PhD, Academic Medical Center - University of Amsterdam (AMC-UvA)
- Study Chair: Arthur A.M. Wilde, MD, PhD, Academic Medical Center - University of Amsterdam (AMC-UvA)
Publications and helpful links
General Publications
- Olde Nordkamp LR, Knops RE, Bardy GH, Blaauw Y, Boersma LV, Bos JS, Delnoy PP, van Dessel PF, Driessen AH, de Groot JR, Herrman JP, Jordaens LJ, Kooiman KM, Maass AH, Meine M, Mizusawa Y, Molhoek SG, van Opstal J, Tijssen JG, Wilde AA. Rationale and design of the PRAETORIAN trial: a Prospective, RAndomizEd comparison of subcuTaneOus and tRansvenous ImplANtable cardioverter-defibrillator therapy. Am Heart J. 2012 May;163(5):753-760.e2. doi: 10.1016/j.ahj.2012.02.012.
- Knops RE, Olde Nordkamp LRA, Delnoy PHM, Boersma LVA, Kuschyk J, El-Chami MF, Bonnemeier H, Behr ER, Brouwer TF, Kaab S, Mittal S, Quast ABE, Smeding L, van der Stuijt W, de Weger A, de Wilde KC, Bijsterveld NR, Richter S, Brouwer MA, de Groot JR, Kooiman KM, Lambiase PD, Neuzil P, Vernooy K, Alings M, Betts TR, Bracke FALE, Burke MC, de Jong JSSG, Wright DJ, Tijssen JGP, Wilde AAM; PRAETORIAN Investigators. Subcutaneous or Transvenous Defibrillator Therapy. N Engl J Med. 2020 Aug 6;383(6):526-536. doi: 10.1056/NEJMoa1915932.
- Knops RE, van der Stuijt W, Delnoy PPHM, Boersma LVA, Kuschyk J, El-Chami MF, Bonnemeier H, Behr ER, Brouwer TF, Kaab S, Mittal S, Quast ABE, Smeding L, Tijssen JGP, Bijsterveld NR, Richter S, Brouwer MA, de Groot JR, Kooiman KM, Lambiase PD, Neuzil P, Vernooy K, Alings M, Betts TR, Bracke FALE, Burke MC, de Jong JSSG, Wright DJ, Jansen WPJ, Whinnet ZI, Nordbeck P, Knaut M, Philbert BT, van Opstal JM, Chicos AB, Allaart CP, Borger van der Burg AE, Clancy JF, Dizon JM, Miller MA, Nemirovsky D, Surber R, Upadhyay GA, Weiss R, de Weger A, Wilde AAM, Olde Nordkamp LRA; PRAETORIAN Investigatorsdouble dagger. Efficacy and Safety of Appropriate Shocks and Antitachycardia Pacing in Transvenous and Subcutaneous Implantable Defibrillators: Analysis of All Appropriate Therapy in the PRAETORIAN Trial. Circulation. 2022 Feb;145(5):321-329. doi: 10.1161/CIRCULATIONAHA.121.057816. Epub 2021 Nov 14.
- Knops RE, Pepplinkhuizen S, Delnoy PPHM, Boersma LVA, Kuschyk J, El-Chami MF, Bonnemeier H, Behr ER, Brouwer TF, Kaab S, Mittal S, Quast ABE, van der Stuijt W, Smeding L, de Veld JA, Tijssen JGP, Bijsterveld NR, Richter S, Brouwer MA, de Groot JR, Kooiman KM, Lambiase PD, Neuzil P, Vernooy K, Alings M, Betts TR, Bracke FALE, Burke MC, de Jong JSSG, Wright DJ, Jansen WPJ, Whinnett ZI, Nordbeck P, Knaut M, Philbert BT, van Opstal JM, Chicos AB, Allaart CP, Borger van der Burg AE, Dizon JM, Miller MA, Nemirovsky D, Surber R, Upadhyay GA, Weiss R, de Weger A, Wilde AAM, Olde Nordkamp LRA. Device-related complications in subcutaneous versus transvenous ICD: a secondary analysis of the PRAETORIAN trial. Eur Heart J. 2022 Dec 14;43(47):4872-4883. doi: 10.1093/eurheartj/ehac496.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- NL34725.018.10 (Other Identifier: Centrale Commissie Mensgebonden Onderzoek)
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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