- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04264182
STandardized Ultra-conservative Or Physician-directed ICD Programming for Continuous Flow LVAD Support
STandardized Ultra-conservative Or Physician-directed ICD Programming for SHOCK Reduction Among Patients on Continuous Flow LVAD Support: a Randomized Controlled Trial (STOP SHOCK LVAD Study)
Study Overview
Status
Intervention / Treatment
Detailed Description
The current International Society for Heart and Lung Transplantation (ISHLT) guidelines provide a class I recommendation for tachy-therapy re-activation in patients with ICDs undergoing LVAD implantation. However, these guidelines reflect a survival benefit observed in cohorts comprised primarily of older-generation pulsatile flow LVADs. While the overall VA prevalence in the LVAD population exceeds 50% with VA usually occurring >200 beats per minute, VA are generally well-tolerated both hemodynamically and symptomatically. Observed LVAD flows do decrease during sustained VA but there are multiple case reports of LVAD patients remaining awake and asymptomatic despite hours of ventricular fibrillation and a large case series reported no deaths and rare syncope due to VA in CF LVAD patients. Contrary to guidelines, contemporary evaluations restricted to CF LVADs show no clear ICD survival benefit in single center studies nor a large, pooled meta-analysis. In fact, propensity-matched analyses of CF LVAD patients in the INTERMACS and UNOS registries have demonstrated increased mortality and more hospitalizations among patients with an active ICD and treated VA. It is unclear in the CF LVAD population whether ICD shocks themselves are harmful or rather identify a higher-acuity patient subgroup. In the general HF population, however, shocks have consistently been associated with worse outcomes. Shock reduction programming resulted in reduced mortality in the MADIT-RIT trial, suggesting shocks may be directly harmful and not only a marker of substrate.
Therefore, the present study will evaluate whether ultra-conservative (UC) programming for ICDs can reduce shocks over standard (physician-discretion) programming among patients with heart failure on CF LVAD support. The model is 1:1 randomization between the two programming strategies for patients with newly implanted CF LVAD devices and a pre-existing ICD. They will be eligible for enrollment during their index hospitalization, and after discharge up to their first outpatient follow-up visit no later than 3 months post discharge. The primary endpoints will be any ICD shock, all-cause mortality, and syncope. The secondary endpoints will be time to first ICD shock, time to first ICD shock for VT/VF, quality of life questionnaire and hospitalizations, including for heart failure and ventricular arrhythmias. The principal exclusion criteria will be pediatric patients, or those without a functional ICD system. Standard of care follow-up will continue thru 24 months.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Ohio
-
Cleveland, Ohio, United States, 44195
- Cleveland Clinic
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Pre-existing ICD
- LVAD placement
Exclusion Criteria:
- Non-functional ICD system
- Uncontrolled ventricular arrhythmias within 7 days of enrollment (defined as VT/VF >30 seconds and/or causing hemodynamic instability and/or symptoms of pre-syncope or syncope)
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 |
---|---|
Experimental: Ultra-conservative ICD programming
Single VF zone programming strategy with maximal detection extension to avoid ICD shock delivery with monitoring-only VT detection zones
|
Re-programming of the ICD device for VA detection (see above)
|
No Intervention: Standard programming (physician discretion)
Usual care ICD programming, which is historically unchanged from ICD programming pre-LVAD
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
ICD shock delivery
Time Frame: Up to 24 months
|
Number of patients with ICD shock delivery
|
Up to 24 months
|
Mortality
Time Frame: Up to 24 Months
|
Incidence of all-cause death
|
Up to 24 Months
|
Syncope
Time Frame: Up to 24 Months
|
Individual occurrence of loss of consciousness
|
Up to 24 Months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time to first ICD shock
Time Frame: Up to 24 Months
|
Interval of time from baseline to first appropriate/non-appropriate ICD shock
|
Up to 24 Months
|
Time to first ICD shock for VT/VF (appropriate shock)
Time Frame: Up to 24 Months
|
Interval of time from baseline to first ICD shock for VT/VF (appropriate shock)
|
Up to 24 Months
|
Standard INTERMACS survey
Time Frame: Up to 24 Months
|
Quality of life measured by INTERMACS survey scored from 1 to 7
|
Up to 24 Months
|
Hospitalization
Time Frame: Up to 24 Months
|
Individual occurrence of hospitalization
|
Up to 24 Months
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Daniel Cantillon, M. D., The Cleveland Clinic
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
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
- 19-656
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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.
Clinical Trials on Heart Failure, Systolic
-
Central Hospital, Nancy, FranceUnknown
-
Zensun Sci. & Tech. Co., Ltd.Active, not recruitingChronic Systolic Heart FailureChina
-
Zensun Sci. & Tech. Co., Ltd.TerminatedChronic Systolic Heart FailureChina
-
Jiangsu HengRui Medicine Co., Ltd.UnknownChronic Systolic Heart FailureChina
-
Hospital Moinhos de VentoTakedaUnknownHeart Failure, Systolic | Systolic Heart Failure | Cardiac FailureBrazil
-
Merck KGaA, Darmstadt, GermanyMerck Ltd.Completed
-
University of NebraskaEli Lilly and Company; Daiichi Sankyo, Inc.Completed
-
Abbott Medical DevicesCompletedSystolic Heart FailureAustralia, Hong Kong, Japan
-
University of CincinnatiCompletedSystolic Heart FailureUnited States
-
GlaxoSmithKlineCompletedHeart Failure, CongestiveKorea, Republic of
Clinical Trials on ICD programming
-
Vanderbilt University Medical CenterThoratec CorporationCompleted
-
Yuksek Ihtisas HospitalCompletedInappropriate ICD Therapy | Appropriate ICD TherapyTurkey
-
M. MeineMedtronic; Tilburg University; Julius CenterUnknown
-
Boston Scientific CorporationCompletedPrimary Prevention of Sudden Cardiac ArrestUnited States
-
Medtronic Bakken Research CenterTerminated
-
Thomas KöglspergerUniversity Hospital Muenster; Heinrich-Heine University, Duesseldorf; University... and other collaboratorsRecruitingParkinson Disease | Telemedicine | Deep Brain StimulationGermany
-
SGX Nova LLCCompletedChronic Back PainUnited States
-
Cairo UniversityRecruitingSystemic Lupus ErythematosusEgypt
-
Academisch Medisch Centrum - Universiteit van Amsterdam...RecruitingParkinson Disease | Deep Brain Stimulation | ImagingNetherlands
-
Jaslok Hospital and Research CentreBoston Scientific CorporationRecruiting