Cardiac Resynchronization Therapy Efficacy Enhancements (CRTee)

The purpose of this study is to demonstrate that the amount of effective CRT (Cardiac Resynchronization Therapy) pacing during AF (atrial fibrillation) when CAFRPlus (Conducted AF Response Plus) is applied is not inferior to the amount of effective CRT pacing during AF when CAFR (Conducted AF Response) is applied.

Study Overview

• Status: Completed
• Conditions: Atrial Fibrillation
• Intervention / Treatment: Device: Conducted AF Response (CAFR); Device: Conducted AF Response Plus (CAFRPlus)

Detailed Description

The CRTee study is an IDE, prospective, multi-center, randomized, controlled, crossover clinical study, conducted worldwide and designed to demonstrate that the amount of effective CRT pacing during AF (atrial fibrillation) when CAFRPlus (Conducted AF Response Plus) is applied is not inferior to the amount of effective CRT pacing during AF when CAFR (Conducted AF Response) is applied.

The study will be conducted at up to 30 centers located in the United States, Europe and Middle East and Africa (MEA).

• Study Type: Interventional
• Enrollment (Actual): 71
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Hungary
  • Budapest, Hungary
    • Magyar Honvédség Honvédkorház
• Italy
  • Roma, Italy
    • Policlinico Universitario Agostino Gemelli
  • Seriate, Italy
    • Azienda Ospedaliera Bolognini Seriate - Ospedale Bolognini
  • Tricase, Italy
    • Azienda Ospedaliera Cardinale Panico
• Saudi Arabia
  • Riyadh, Saudi Arabia
    • Prince Sultan Cardiac Center
• Slovakia
  • Kosice, Slovakia
    • Východoslovenský Ústav Srdcových A Cievnych Chorôb, A.S.
• South Africa
  • Cape Town, South Africa
    • Mediclinic Panorama
• United Kingdom
  • Liverpool, United Kingdom
    • Liverpool Heart and Chest Hospital NHS Foundation Trust
  • Newcastle Upon Tyne, United Kingdom
    • he Newcastle upon Tyne Hospitals NHS Foundation Trust - Freeman Hospital
• United States
  • Florida
    • Boca Raton, Florida, United States
      • Cardiac Arrythmia Services
  • Iowa
    • West Des Moines, Iowa, United States
      • Iowa Heart Center
  • Minnesota
    • Minneapolis, Minnesota, United States
      • North Memorial Heart and Vascular
    • St. Cloud, Minnesota, United States
      • CentraCare
  • North Carolina
    • Raleigh, North Carolina, United States
      • North Carolina Heart and Vascular
  • Ohio
    • Columbus, Ohio, United States
      • Mount Carmel
  • Oklahoma
    • Oklahoma City, Oklahoma, United States
      • Oklahoma Heart
  • Pennsylvania
    • Reading, Pennsylvania, United States
      • Berks Cardiology
  • Texas
    • Austin, Texas, United States, 78705
      • Texas Cardiac Arrhythmia Services
  • Washington
    • Spokane, Washington, United States
      • Kootenai Heart Clinics

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Subject is willing to sign and date the study patient Informed Consent form.
• Subject is at least 18 years of age (or older, if required by local law).
• Subject is expected to remain available after enrollment to complete follow-up visits in both arms of the study
• Subject has had a Medtronic Viva or Brava CRT-D device implanted at least 30 days prior to enrollment.
• Subject has history of AF burden, of at least 6 days of at least 4 hours of AF over any 4 week period within the last 90 days as documented in device diagnostic data OR if subject has no atrial lead (therefore no device diagnostic data) but clinical evidence of high AF burden.
• Subject has demonstrated history of being able to complete Left Ventricular Capture Management (LVCM) documented in device data.
• Subject has a documented % V pacing during AF of less than or equal to 97% within 90 days prior to enrollment or within 10 days after enrollment.

Exclusion Criteria:

• Subject has undergone AV node ablation for treatment of AF.
• Subject has complete or 3rd degree AV block.
• Subject has had an MI within 30 days.
• Subject has medical conditions that limit study participation (per physician discretion).
• Subject is enrolled in one or more concurrent studies that could confound the study results as determined by Medtronic.
• Subject has a limited life expectancy for non-cardiac causes that would not allow completion of the study.
• Subject is pregnant (in the US, all women of child-bearing potential must undergo a pregnancy test within seven days prior to CRTee download).
• Subject meets the exclusion criteria required by local law.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Group A: CAFR first; Subjects randomized to Group A will receive CAFR first, then cross over to CAFRPlus.	Device: Conducted AF Response (CAFR); The CAFR algorithm is currently available in the Medtronic market-released devices and intended to promote delivery of CRT pacing during conducted AT/AF episodes.; Device: Conducted AF Response Plus (CAFRPlus); The CAFRPlus algorithm is part of the CRTee feature set. This feature set has a diagnostic element that tracks the loss of effective CRT pacing that is occurring over time, both during normal sinus rhythm (NSR) and during AF. It also has an interventional element (i.e. CAFRPlus) that uses this evaluation of effective CRT pacing to adjust the pacing rate during AF to decrease loss of effective CRT pacing.
Other: Group B: CAFRPlus first; Subjects randomized to Group B will receive CAFRPlus first, then cross over to CAFR.	Device: Conducted AF Response (CAFR); The CAFR algorithm is currently available in the Medtronic market-released devices and intended to promote delivery of CRT pacing during conducted AT/AF episodes.; Device: Conducted AF Response Plus (CAFRPlus); The CAFRPlus algorithm is part of the CRTee feature set. This feature set has a diagnostic element that tracks the loss of effective CRT pacing that is occurring over time, both during normal sinus rhythm (NSR) and during AF. It also has an interventional element (i.e. CAFRPlus) that uses this evaluation of effective CRT pacing to adjust the pacing rate during AF to decrease loss of effective CRT pacing.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Effective CRT Pacing During AF (Non-inferiority Test)	The primary objective is to demonstrate that the percent effective CRT pacing during AF when CAFRPlus is applied is not inferior to when CAFR is applied (non-inferiority test).	Up to 4 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Effective CRT Pacing During AF (Superiority Test)	The secondary objective is to demonstrate that the percent effective CRT pacing during AF when CAFRPlus is applied is greater than when CAFR is applied (superiority test).	Up to 4 months

Collaborators and Investigators

• Sponsor: Medtronic Cardiac Rhythm and Heart Failure
• Investigators: Principal Investigator: Suneet Mittal, MD, Valley Health System

Publications and helpful links

General Publications

• Plummer CJ, Frank CM, Bari Z, Al Hebaishi YS, Klepfer RN, Stadler RW, Ghosh S, Liu S, Mittal S. A novel algorithm increases the delivery of effective cardiac resynchronization therapy during atrial fibrillation: The CRTee randomized crossover trial. Heart Rhythm. 2018 Mar;15(3):369-375. doi: 10.1016/j.hrthm.2017.10.026. Epub 2017 Nov 11.

Study record dates

Study Major Dates

• Study Start: October 1, 2014
• Primary Completion (Actual): January 1, 2016
• Study Completion (Actual): January 1, 2016

Study Registration Dates

• First Submitted: August 19, 2014
• First Submitted That Met QC Criteria: August 20, 2014
• First Posted (Estimate): August 21, 2014

Study Record Updates

• Last Update Posted (Estimate): January 6, 2017
• Last Update Submitted That Met QC Criteria: November 8, 2016
• Last Verified: November 1, 2016

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Heart Diseases; Cardiovascular Diseases; Arrhythmias, Cardiac; Atrial Fibrillation
• Other Study ID Numbers: CRTee

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO