- ICH GCP
- US Clinical Trials Registry
- Klinisk forsøg NCT01169493
Pacing Affects Cardiovascular Endpoints in Patients With Right Bundle-Branch Block (The PACE-RBBB Trial) (PACE-RBBB)
1. august 2016 opdateret af: Duke University
Heart failure (HF) affects 5 million Americans and is responsible for more health-care expenditure than any other medical diagnosis.
Approximately half of all HF patients have electrocardiographic prolongation of the QRS interval and ventricular dyssynchrony, a perturbation of the normal pattern of ventricular contraction that reduces the efficiency of ventricular work.
Ventricular dyssynchrony is directly responsible for worsening HF symptomatology in this subset of patients.
Resynchronization of ventricular contraction is usually achieved through simultaneous pacing of the left and right ventricles using a biventricular (BiV) pacemaker or implantable cardioverter-defibrillator.
Clinical trial evidence supporting the use of BiV pacing in patients with prolonged QRS duration was obtained almost exclusively in patients with a left bundle-branch block (LBBB) electrocardiographic pattern.
Recent evidence suggests that resynchronization of ventricular contraction in patients with LBBB can be obtained by univentricular left ventricular pacing with equal or superior clinical benefits compared to BiV pacing.
Animal studies suggest that ventricular resynchronization can be obtained in subjects with right bundle-branch block (RBBB) through univentricular right ventricular pacing.
No clinical trial evidence exists to support the use of BiV pacing in patients with RBBB.
Thousands of patients with symptomatic HF and RBBB currently have univentricular ICDs in place for the prevention of sudden cardiac death.
Most of these devices are currently programmed to avoid RV pacing.
We aim to determine if ventricular resynchronization delivered through univentricular RV pacing improves symptoms in patients with RBBB and moderate to severe HF who have previously undergone BiV ICD implantation for symptomatic heart failure.
We further aim to determine if ventricular resynchronization improves myocardial performance and ventricular geometry as detected by echocardiographic measures and quality of life for patients with HF and RBBB.
We hypothesize that RV univentricular pacing delivered with an atrio-ventricular interval that maximizes ventricular synchrony is equivalent to BiV pacing for improvement in cardiac performance, HF symptoms, and positive ventricular remodeling in patients with HF and RBBB.
Studieoversigt
Status
Afsluttet
Betingelser
Intervention / Behandling
Undersøgelsestype
Interventionel
Tilmelding (Faktiske)
16
Fase
- Ikke anvendelig
Kontakter og lokationer
Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.
Studiesteder
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North Carolina
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Durham, North Carolina, Forenede Stater, 27710
- Duke University Medical Center
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Durham, North Carolina, Forenede Stater, 27710
- Durham VA Medical Center
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Deltagelseskriterier
Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.
Berettigelseskriterier
Aldre berettiget til at studere
18 år og ældre (Voksen, Ældre voksen)
Tager imod sunde frivillige
Ingen
Køn, der er berettiget til at studere
Alle
Beskrivelse
Inclusion Criteria:
- Cardiomyopathy of either idiopathic or ischemic etiology
- NYHA class III, or IV symptoms
- Sinus rhythm
- QRS complex duration > 130 msec in ≥ 2 surface ECG leads with RBBB
- PR interval > 150 msec and < 240 msec
- Prior implantation of dual chamber BiV ICD with apical RV lead location
Exclusion Criteria:
- Myocardial infarction, major surgical procedure, or acute cardiac failure crisis requiring inotropes within 6 months of entry into the study
- Atrial fibrillation or flutter lasting >12 hours within the last 6 months
- Sick sinus syndrome, complete heart block, or other arrhythmias requiring pacemaker support
- Pregnancy
- Any other known condition other than heart failure that could limit exercise time or survival to < 6 months
Studieplan
Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Crossover opgave
- Maskning: Tredobbelt
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
---|---|
Eksperimentel: VVI-40 to RV DDD-40 to Bi-V DDD-40
Period 1: Participants assigned to VVI-40 Participants will then Crossover to Period 2. Period 2: Participants assigned to RV DDD-40 Participants will then Crossover to Period 3. Period 3: Participants assigned to Bi-V DDD-40
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Pacing mode set to VVI-40, RV only pacing
ICD programmed to DDD-40, RV only pacing with aan AV interval producing QRS fusion on surface EKG.
ICD programmed to BiV pacing at a lower rate of 40
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Eksperimentel: VVI-40 to Bi-V DDD-40 to RV DDD-40
Period 1: Participants assigned to VVI-40 Participants will then Crossover to Period 2. Period 2: Participants assigned to Bi-V DDD-40 Participants will then Crossover to Period 3. Period 3: Participants assigned to RV DDD-40
|
Pacing mode set to VVI-40, RV only pacing
ICD programmed to DDD-40, RV only pacing with aan AV interval producing QRS fusion on surface EKG.
ICD programmed to BiV pacing at a lower rate of 40
|
Eksperimentel: Bi-V DDD-40 to VVI-40 to RV DDD-40
Period 1: Participants assigned to Bi-V DDD-40 Participants will then Crossover to Period 2. Period 2: Participants assigned to VVI-40 Participants will then Crossover to Period 3. Period 3: Participants assigned to RV DDD-40
|
Pacing mode set to VVI-40, RV only pacing
ICD programmed to DDD-40, RV only pacing with aan AV interval producing QRS fusion on surface EKG.
ICD programmed to BiV pacing at a lower rate of 40
|
Eksperimentel: Bi-V DDD-40 to RV DDD-40 to VVI-40
Period 1: Participants assigned to Bi-V DDD-40 Participants will then Crossover to Period 2. Period 2: Participants assigned to RV DDD-40 Participants will then Crossover to Period 3. Period 3: Participants assigned to VVI-40
|
Pacing mode set to VVI-40, RV only pacing
ICD programmed to DDD-40, RV only pacing with aan AV interval producing QRS fusion on surface EKG.
ICD programmed to BiV pacing at a lower rate of 40
|
Eksperimentel: RV DDD-40 to VVI-40 to Bi-V DDD-40
Period 1: Participants assigned to RV DDD-40 Participants will then Crossover to Period 2. Period 2: Participants assigned to VVI-40 Participants will then Crossover to Period 3. Period 3: Participants assigned to Bi-V DDD-40
|
Pacing mode set to VVI-40, RV only pacing
ICD programmed to DDD-40, RV only pacing with aan AV interval producing QRS fusion on surface EKG.
ICD programmed to BiV pacing at a lower rate of 40
|
Eksperimentel: RV DDD-40 to Bi-V DDD-40 to VVI-40
Period 1: Participants assigned to RV DDD-40 Participants will then Crossover to Period 2. Period 2: Participants assigned to Bi-V DDD-40 Participants will then Crossover to Period 3. Period 3: Participants assigned to VVI-40
|
Pacing mode set to VVI-40, RV only pacing
ICD programmed to DDD-40, RV only pacing with aan AV interval producing QRS fusion on surface EKG.
ICD programmed to BiV pacing at a lower rate of 40
|
Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Tidsramme |
---|---|
The Primary Endpoint of the Trial Will be a Comparison of the Proportion of Patients in Each of the Three Treatment Groups Who Demonstrate Positive LV Remodeling, Defined as a Decrease in LV End Systolic Diameter of >5mm.
Tidsramme: 6 months
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6 months
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Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
---|---|---|
Venstre ventrikulær ejektionsfraktion (LVEF)
Tidsramme: 6 måneder
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6 måneder
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Secondary Echocardiographic Endpoints
Tidsramme: 6 months
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Comparisons of the derived velocity-time integral calculated on the aortic continuous wave Doppler-spectrogram, RV end-diastolic size, RV EF, mitral and tricuspid regurgitation severity, and estimated RV systolic pressure.
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6 months
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Arrhythmic Events
Tidsramme: 6 months
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To determine if pacing mode impacts the frequency of ventricular arrhythmias, the incidence of ventricular tachyarrhythmia episodes on device interrogation will be compared between treatment group assignments.
An episode will be considered ventricular arrhythmia if it lasts longer than 30 seconds or requires anti-tachycardia pacing or high voltage device therapy for termination.
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6 months
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Minnesota Quality of Life Questionnaire
Tidsramme: 6 months
|
This is a standardized method for assessing quality of life in patients with heart failure.
It asks 21 questions and measures the impact HF has on a subject's life.
Each question is rated 0-5.
The total score for the 21 items can range from 0 to 105.
Higher scores indicate more burden of disease on quality of life.
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6 months
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6-minute Walk Distance
Tidsramme: 6 months
|
6-minute walk distance was the distance that a participant could walk in 6 minutes.
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6 months
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NYHA Function Class
Tidsramme: 6 months
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The New York Heart Association (NYHA) Functional Classification places patients in one of four categories based on how much they are limited during physical activity.
Class I means there is no limitation of physical activity and Class IV means a person is unable to carry on any physical activity without discomfort/symptoms of heart failure at rest.
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6 months
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Left Ventricular End-diastolic Size
Tidsramme: 6 months
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6 months
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Samarbejdspartnere og efterforskere
Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.
Sponsor
Samarbejdspartnere
Efterforskere
- Ledende efterforsker: Brett D Atwater, MD, Duke University
Datoer for undersøgelser
Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.
Studer store datoer
Studiestart
1. januar 2011
Primær færdiggørelse (Faktiske)
1. august 2014
Studieafslutning (Faktiske)
1. august 2014
Datoer for studieregistrering
Først indsendt
22. juli 2010
Først indsendt, der opfyldte QC-kriterier
22. juli 2010
Først opslået (Skøn)
26. juli 2010
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Skøn)
23. september 2016
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
1. august 2016
Sidst verificeret
1. august 2016
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
- Pro00025144
- 10CRP3630033 (Andet bevillings-/finansieringsnummer: American Heart Association)
Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .
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