Synchronized Diaphragmatic Stimulation in Symptomatic Heart Failure (RECOVER-HF)

RECOVER-HF - RandomizEd, Multi-Center, Double-Blinded Study of SynchrOnized Diaphragmatic Stimulation (SDS) for ImproVEment of Symptomatic Reduced Ejection Fraction Heart Failure

RECOVER HF is a clinical study designed to evaluate the safety and efficacy of Synchronized Diaphragmatic Stimulation delivered using the VisONE System in the treatment of patients with heart failure.

Study Overview

• Status: Recruiting
• Conditions: Heart Failure With Reduced Ejection Fraction
• Intervention / Treatment: Device: Synchronized Diaphragmatic Stimulation

Detailed Description

Symptomatic Diaphragmatic Stimulation (SDS) is a novel extra-cardiac device for patients who have symptomatic heart failure. Elevated intracardiac pressures are the hallmark of heart failure (HF) and a key pathological driver of disease progression and limited exertional capacity. The degree of cardiac pressure elevation is determined by preload, afterload, and pericardial restraint. The pericardium restrains the heart, and the degree of restraint is determined by the pericardial structure itself and the intrathoracic pressure. This aspect of HF pathophysiology is among the fundamental drivers behind the SDS therapy concept. SDS induces a temporal modulation of intrathoracic pressure.. When synchronized with the cardiac cycle, SDS may improve cardiac filling, cardiovascular pressure conditions, and cardiac performance

RECOVER HF is a prospective, randomized, doubled-blinded study of Synchronized Diaphragmatic Stimulation (SDS) delivered in an imperceptible manner in subjects with heart failure defined as New York Heart Association (NYHA) functional class II/III, left-ventricular ejection fraction (LVEF) <=40%, and QRS duration <=130ms despite receiving the appropriate heart failure guideline directed medical therapy (GDMT). All subjects will receive an implanted VisONE System. Two-weeks post implant subjects will be randomized in a 1:1 ratio into a SDS therapy active or control (SDS therapy inactive) arm with both arms receiving GDMT. At 6 months the control arm will have SDS therapy activated with all patients receiving therapy and GDMT throughout the remainder of the study period. The study will be conducted at up to 30 investigational sites in the United States and several outside the U.S. These centers will enroll subjects with the goal of randomizing approximately 270 subjects who meet the entry criteria.

• Study Type: Interventional
• Enrollment (Estimated): 270
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Patricia Arand, Ph.D.; Phone Number: 5034313823; Email: arandp@viscardia.com
• Study Contact Backup: Name: Peter Bauer, Ph.D.; Phone Number: 5034313824; Email: bauerp@viscardia.com

Study Locations

• United States
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19104
      • Recruiting
      • University of Pennsylvania
      • Contact: Aditya Parikh, MD; Phone Number: (215) 615-4949; Email: aditya.parikh@pennmedicine.upenn.edu
      • Principal Investigator: Aditya Parikh, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• NYHA classes II/III on optimal Guideline Directed Medical Therapy (GDMT)
• QRS duration ≤ 130 ms
• EF≤ 40%

Exclusion Criteria:

• Baseline 6 minute walk test > 500 meters or < 200 meters
• NT-proBNP< 250 if on loop diuretics, or NT-proBNP < 500 if not on loop diuretics
• Supine resting heart rate > 140 bpm
• Systolic blood pressure < 80 mmHg or > 170 mmHg
• Serum creatinine > 2.5 mg/dL
• Serum hepatic function 3x ULN
• Any of the following within the previous 3 months: unstable angina, AMI, CABG, PTCA, CVA/TIA, persistent AF (> 24 hours), symptomatic NSVT or DCCV
• Any inotropic drug treatment within the previous 3 months
• Bradycardia (heart rate < 50 beats/min), atrial arrhythmias with rates > 100 beats/min, sustained ventricular tachycardia or frequent ventricular ectopy >10% present during screening
• Significant uncontrolled symptomatic bradyarrhythmia, atrial fibrillation, unstable ventricular arrhythmias or frequent ventricular ectopy > 10% documented within the previous 3 months
• Reversible non-ischemic cardiomyopathy

• Valvular disease requiring intervention within the next 12 months or presence of significant valve disease as determined by the site cardiologist as:

  1. Greater than mild mitral valve stenosis
  2. Greater than moderate mitral valve regurgitation
  3. Greater than mild tricuspid valve stenosis
  4. Greater than moderate-severe tricuspid valve regurgitation
  5. Greater than moderate aortic stenosis
  6. Greater than moderate aortic regurgitation
  7. Greater than mild-moderate pulmonic stenosis
  8. Greater than moderate pulmonic regurgitation
• Severe primary pulmonary disease, including pulmonary arterial hypertension. PAP sys >70 mmHg at rest
• Severe COPD, other respiratory or lung diseases where FEV < 50%
• Presence of more than small pleural effusion or history of pleural drainage within the previous 6 months
• Known history of diaphragmatic paralysis or suspicion confirmed by unilateral or bilateral elevation of the diaphragm on chest x-ray
• Pericardial disease
• Diabetic neuropathy
• Existing diaphragmatic stimulation for respiration assist
• Present LVAD, Baroreflex Activation Therapy, Cardiac Contractility Modulation or interatrial shunt devices; temporary mechanical cardiac assist devices (current or within the previous 3 months); or CRT that is indicated or implanted and functional
• Contraindications to laparoscopic access to the diaphragm, as determined by the implanting physician
• Known intra-abdominal pathology which could increase the risk of laparoscopic access to the diaphragm.
• Previous open laparotomy within 1 year
• Previous thoracic or abdominal organ transplant
• Drug induced immuno-suppression
• Body mass index > 40
• Enrollment in a concurrent investigation / clinical study
• Having a life expectancy of <1 year due to any condition
• Pregnant or planning a pregnancy during the study period
• Known allergies to implantable device materials
• History of systemic infection requiring the use of intravenous antibiotics within the previous 3 months

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Device and Medical Management; Subjects will be implanted with the VisONE System programmed to deliver SDS (Therapy On) and receive optimal, stable, Guideline Directed Medical Therapy (GDMT) for heart failure (American Heart Association [AHA] / American College of Cardiology [ACC] guidelines) including those drugs to be determined by the subject's physician; Assigned Interventions:Device: VisONE System (SDS)Drug: Medical Management	Device: Synchronized Diaphragmatic Stimulation; Implantable Pulse Generator system providing cardiac-gaited stimulation of the diaphragm and thereby influence cardiovascular properties relevant in heart failure.; Other Names: SDS; Asymptomatic Diaphragmatic Stimulation; ADS; VisONE SDS
Sham Comparator: Medical Management; Subjects will be implanted with the VisONE System programmed not to deliver SDS (Therapy Off) and receive optimal, stable, Guideline Directed Medical Therapy (GDMT) for heart failure (American Heart Association [AHA] / American College of Cardiology [ACC] guidelines) including those drugs to be determined by the subject's physician; Assigned Interventions:Drug: Medical Management	Device: Synchronized Diaphragmatic Stimulation; Implantable Pulse Generator system providing cardiac-gaited stimulation of the diaphragm and thereby influence cardiovascular properties relevant in heart failure.; Other Names: SDS; Asymptomatic Diaphragmatic Stimulation; ADS; VisONE SDS

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Left ventricular End-Systolic Volume (LVESV)	To demonstrate that treatment with the VisONE System (SDS) plus GDMT results in a larger percent improvement in LVESV at 6 months post-randomization from baseline than medical management alone.	6 months
Six Minute Hall Walk (6MHW)	To demonstrate that treatment with the VisONE System (SDS) plus GDMT results in a larger improvement in 6MHW at 6 months post-randomization from baseline than medical management alone.	6 months
Minnesota Living with Heart Failure quality of Life Score (MLWHF QOL)	To demonstrate that treatment with the VisONE System (SDS) plus GDMT results in a larger improvement in MLWHF QOL at 6 months post-randomization from baseline than medical management alone.	6 months
Major Adverse Respiratory and Cardiovascular Events (MARCE)	To demonstrate the safety of the VisONE System by analyzing Major Adverse Respiratory and Cardiovascular Events (MARCE) occurring within 6 months post implant for the rate, severity and association with the device or procedure (goal >70% freedom): Cardiovascular Death; Stroke; Cardiac Arrest; Interaction with cardiac rhythm device requiring permanent termination of SDS therapy; Acute Heart Failure Decompensation; Infection requiring device/lead explant; Diaphragmatic dysfunction leading to a clinically significant reduction is respiratory function; Inadequate SDS therapy delivery requiring surgical intervention; Injury to abdominal organs requiring surgical intervention; Pneumothorax; Hemothorax	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Left Ventricular Ejection Fraction (LVEF)	To demonstrate that treatment with the VisONE System (SDS) plus GDMT results in a larger improvement in LVEF at 6 months post-randomization from baseline than medical management alone.	6 months
N-Terminal Pro Brain Natriuretic Peptide (NT-proBNP)	To demonstrate that treatment with the VisONE System (SDS) plus GDMT results in a larger reduction in NT-proBNP (log-10 transformed) at 6 months post-randomization from baseline than medical management alone.	6 months
Left ventricular End-Systolic Volume (LVESV)	To demonstrate that treatment with the VisONE System (SDS) plus GDMT results in a larger percent improvement in LVESV at 12 months post-randomization from baseline than medical management alone.	12 months
Six Minute Hall Walk (6MHW)	To demonstrate that treatment with the VisONE System (SDS) plus GDMT results in a larger improvement in 6MHW at 12 months post-randomization from baseline than medical management alone.	12 months
Minnesota Living with Heart Failure quality of Life Score (MLWHF QOL)	To demonstrate that treatment with the VisONE System (SDS) plus GDMT results in a larger improvement in MLWHF QOL at 12 months post-randomization from baseline than medical management alone.	12 months
Left Ventricular Ejection Fraction (LVEF)	To demonstrate that treatment with the VisONE System (SDS) plus GDMT results in a larger improvement in LVEF at 12 months post-randomization from baseline than medical management alone.	12 months
N-Terminal Pro Brain Natriuretic Peptide (NT-proBNP)	To demonstrate that treatment with the VisONE System (SDS) plus GDMT results in a larger reduction in NT-proBNP (log-10 transformed) at 12 months post-randomization from baseline than medical management alone.	12 months

Collaborators and Investigators

• Sponsor: VisCardia Inc.
• Collaborators: Duke Clinical Research Institute; Clinical Accelerator
• Investigators: Principal Investigator: Lee R Goldberg, MD, University of Pennsylvania

Study record dates

Study Major Dates

• Study Start (Estimated): April 30, 2026
• Primary Completion (Estimated): July 1, 2028
• Study Completion (Estimated): December 1, 2029

Study Registration Dates

• First Submitted: August 6, 2024
• First Submitted That Met QC Criteria: August 9, 2024
• First Posted (Actual): August 14, 2024

Study Record Updates

• Last Update Posted (Actual): March 31, 2026
• Last Update Submitted That Met QC Criteria: March 27, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Heart Failure; Heart Disease; Synchronized Diaphragmatic Stimulation; Implantable Heart Failure Device Therapy
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Heart Failure; Heart Diseases
• Other Study ID Numbers: VisCardia H03_22

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes