Early Elimination of Premature Ventricular Contractions in Heart Failure

EVAC-HF is a Prospective, Multi-center, Randomized Study to Compare the Effects on LV Systolic Function Following Radiofrequency Catheter Ablation of Frequent Premature Ventricular Contraction With Optimized Medical Therapy Alone.

Sponsors

Lead Sponsor: University of Maryland, Baltimore

Collaborator: Biosense Webster, Inc.

Source University of Maryland, Baltimore
Brief Summary

Premature ventricular contractions (PVC) are a very common irregular heart beat (arrhythmias) even in patients without heart disease. Frequent PVCs are thought to occur in about 1-4% of the general population. Many patients with PVCs complain about skipping of their heart (palpitations), shortness of breath and feeling tired. In some patients PVCs may also result in weakening of the heart muscle (heart failure), which might be reversible with suppression of the PVCs.

Detailed Description

A common way to get rid of PVCs is an ablation procedure during which a small area of heart muscle that creates the PVCs is cauterized, so that it can no longer cause PVCs. This has been performed for many years and is an overall safe and effective procedure to eliminate PVCs. In the ablation, a catheter with an electrode at its tip is guided with moving X-rays (fluoroscopy) displayed on a video screen to the exact site inside the heart where cells give off the electrical signals that stimulate the abnormal heart rhythm. Radiofrequency energy (similar to microwave heat) is transmitted from the catheter tip to the area. This destroys carefully selected heart muscle cells in a very small area (about 1/5 of an inch) and can stop the area from creating the extra impulses that cause the extra heartbeats. Additionally, some medications have the ability to suppress PVCs (antiarrhythmic medications). PVC ablation and antiarrhythmic medications have both been used to treat patients with PVC's and a reduced heart function. The heart function is referred to as ejection fraction (measured by cardiac ultrasound (echocardiogram). In this study it will be required the ejection fraction will be less than less than or equal to 45% (with 55% or more being normal). If enrolled in the study there is a 50/50 chance (like a coin toss and referred to as randomization) that the patient will either continue on the best currently available medical treatment for a weak heart muscle (as determined by the doctor) or will undergo a PVC catheter ablation (with a possible second ablation or antiarrhythmic medication, if the first ablation was not a success). All patients in the study will continue to take the best possible medications for the heart muscle weakness. If the patient is randomized to not undergo the ablation they will be monitored and at the end of 6 months of participation may choose to have the PVC ablation. If a deterioration may occur patients in the control group can have an ablation earlier.

Overall Status Terminated
Start Date 2013-01-01
Completion Date 2017-05-17
Primary Completion Date 2017-05-17
Phase N/A
Study Type Interventional
Primary Outcome
Measure Time Frame
Change of Left Ventricular Ejection Fraction Measured With Simpson's Rule Expressed in Percent From Pre to Post Intervention Change between 0 and 6 months
Enrollment 3
Condition
Intervention

Intervention Type: Device

Intervention Name: PVC ablation

Description: This will compare symptoms, safety between ablation procedure vs medical therapy. Biosense Catheter used is not indicated specifically for PVC ablations and will be evaluated

Arm Group Label: ablation procedure vs medical therapy

Other Name: Surround Flow ablation catheters- Biosense Webster

Eligibility

Criteria:

Inclusion Criteria: - Patients with reduced ejection fraction (EF ≤45%) demonstrated by transthoracic echocardiogram and deemed to be non-ischemic by nuclear stress test or cardiac catheterization. - Patients with >20% PVCs on 24 hour holter-recording - Patient is 18 years of age or older - Optimized medical therapy on stable therapy for minimum 3 months with no changes in beta-blocker, ACE-I/ARB, digoxin doses (varying diuretic doses permitted). Exclusion Criteria: - Patients who are under the age of 18 years of age - Patients with >2 dominant PVC morphologies - Patients with cardiac surgery in previous 3 months or scheduled for following 6 months - Patients who were implanted with a biventricular device during the last three months or single/dual chamber device (with ventricular pacing >10%) during the last three months - Significant symptoms associated with PVCs that would make favor immediate ablation - Intracardiac mural thrombus or myxoma - Pregnancy

Gender:

All

Minimum Age:

18 Years

Maximum Age:

N/A

Healthy Volunteers:

No

Overall Official
Last Name Role Affiliation
Timm Dickfeld, MD Principal Investigator University of Maryland, College Park
Location
Facility:
UCLA | Los Angeles, California, 90095, United States
University of Maryland Medical Center | Baltimore, Maryland, 21201, United States
University maryland medical Center | Baltimore, Maryland, 21229, United States
Brigham and Women's Hospital | Boston, Massachusetts, 02115, United States
University of Michigan | Ann Arbor, Michigan, 48109-311, United States
Ohio State University | Columbus, Ohio, 43210-1252, United States
University of Pennsylvania | Philadelphia, Pennsylvania, 19104, United States
University of Quebec | Sainte-Foy, Quebec, G1V4G5, Canada
Location Countries

Canada

United States

Verification Date

2021-02-01

Responsible Party

Type: Principal Investigator

Investigator Affiliation: University of Maryland, Baltimore

Investigator Full Name: Timm-Michael Dickfeld

Investigator Title: Principal Investigator

Keywords
Has Expanded Access No
Condition Browse
Number Of Arms 2
Arm Group

Label: ablation procedure vs medical therapy

Type: Active Comparator

Description: PVC ablation vs medical therapy

Label: Compare 2 arms for safety, symptoms

Type: No Intervention

Description: Compare control of PVC's between 2 groups.

Acronym EVAC-HF
Patient Data No
Study Design Info

Allocation: Randomized

Intervention Model: Parallel Assignment

Primary Purpose: Treatment

Masking: None (Open Label)

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