- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03450252
Pacemaker Therapy for Drug-refractory Symptoms in Mid-cavity Hypertrophic Cardiomyopathy
Distal Ventricular Pacing and Intraventricular Gradient Reduction for Symptomatic Relief in Drug Refractory Hypertrophic Cardiomyopathy Patients With Mid-cavity Obstruction
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Hypertrophic cardiomyopathy (HCM) is the most common inherited heart disease, affecting 1 in 500 of the general population. It is characterised by abnormal thickening of the heart muscle. The various patterns of thickening of the muscle in the main pumping chamber, or left ventricle (LV), can result in obstruction to blood flow within the heart, raising the pressures in the heart and placing extra strain on the heart muscle.
The obstruction can cause patients to suffer from symptoms such as shortness of breath and chest pain, along with poor exercise tolerance, and dizzy spells. In very symptomatic patients with the commonest type of obstruction, invasive procedures performed either via an open-heart or keyhole operation can reduce the increased basal septal muscle mass at the point of obstruction. However, in around 1 in 10 HCM patients, the obstruction is deep within the LV where a ring of thick muscle blocks blood flow when it contracts. These patients provide a challenge for doctors, as this type of obstruction is much less suitable for open heart or keyhole operation.
An alternative is to use a cardiac pacemaker to alter the timing of the contraction in the ring of thick muscle such that different parts of the ring contract at different times and thereby reduce obstruction to blood flow. The investigators' early experience with this new treatment shows that carefully placing the pacemaker wires can reduce the obstruction and improve patient symptoms.
Key questions of this research include:
- How much can optimal ventricular pacing reduce the obstruction by?
- How important is choosing which part of the heart the pacemaker activates first?
- Does reducing obstruction in this way make patients better in the short and long term?
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Thames
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London, Thames, United Kingdom, EC1A 7BE
- Barts Heart Centre
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Male or female, >18 years.
- Referred for PPM +/- ICD implantation for either primary prevention of sudden cardiac death or other indications such as heart block or obstructive physiology.
- HCM patients with evidence of mid-cavity gradient demonstrated by echocardiography and gradient ≥30 mmHg confirmed by cardiac catheterisation at rest or with isoprenaline provocation.
- All patients should be taking maximum tolerated doses of beta blockers or verapamil with or without disopyramide.
- Symptoms refractory to optimum medical therapy as above, for example breathlessness, chest pain, dizziness, or syncope.
Exclusion Criteria:
- Patients with multi-level obstruction, i.e. across the mid-cavity and outflow tract.
- Patients with moderate or severe valvular stenosis or regurgitation.
- Patients with a history of myocardial infarction or acute coronary syndrome.
- Patients unable to provide informed consent.
- Patients in atrial fibrillation.
- Pregnancy.
- Renal failure.
- If considered unsuitable by clinician.
- Patients already participating in trials involving invasive procedures.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Active pacing
Active ventricular pacing.
The pacemaker is set-up with a short atrio-ventricular delay to allow for appropriate pacing capture of the ventricle.
|
Ventricular pacing via the invasive haemodynamic study-defined optimal pacing site in order to relieve pressure gradient across the mid-cavity obstruction in mid-cavity obstructive variant hypertrophic cardiomyopathy.
|
Sham Comparator: Back-up pacing
Back-up pacing.
The pacemaker is set-up to sense and pace only in the right atrium (AAI) without any pacing capacity in the ventricle.
|
Back-up pacing.
The pacemaker is set-up to sense and pace only in the right atrium (AAI) without any pacing capacity in the ventricle.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Invasive gradient (mmHg)
Time Frame: Measured during pacemaker implant. Pressure gradients will be measured at different pacing sites during the implant.
|
Acute invasively defined gradient change in mmHg across the mid-cavity with optimal ventricular pacing setting
|
Measured during pacemaker implant. Pressure gradients will be measured at different pacing sites during the implant.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Symptomatic assessment via SF36 questionnaire
Time Frame: Pre-implant, 4 months, and 8 months
|
Generalised health related questionnaire
|
Pre-implant, 4 months, and 8 months
|
Symptomatic assessment via Kansas City Cardiomyopathy questionnaire
Time Frame: Pre-implant, 4 months, and 8 months
|
Cardiomyopathy health related questionnaire
|
Pre-implant, 4 months, and 8 months
|
Symptomatic assessment via calculation of New York Heart Association (NYHA) functional class
Time Frame: Pre-implant, 4 months, and 8 months
|
Classification of extent of heart failure
|
Pre-implant, 4 months, and 8 months
|
Exercise performance assessed by 6 minute walk test (6MWT)
Time Frame: Pre-implant, 4 months, and 8 months
|
Sub-maximal exercise test
|
Pre-implant, 4 months, and 8 months
|
Exercise performance assessed by Cardiopulmonary exercise testing (CPET) stress echocardiography.
Time Frame: Pre-implant, 4 months, and 8 months
|
Maximal exercise test with simultaneous echocardiography
|
Pre-implant, 4 months, and 8 months
|
Levels of Brain Natriuretic Peptide
Time Frame: Pre-implant, 4 months, and 8 months
|
Protein associated with heart failure
|
Pre-implant, 4 months, and 8 months
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Saidi A Mohiddin, BSc, MBChB, FRCP, MD, Barts Health NHS Trust and Queen Mary University of London
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- V11_27 10 20
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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