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Electrical Activation Mapping Guided Tailor Made Approach for Cardiac Resynchronization Therapy

18 de octubre de 2021 actualizado por: Professor Bryan Ping Yen YAN, Chinese University of Hong Kong

Background

Cardiac Resynchronization Therapy (CRT) is proven to improve survival and heart function of patient with certain electrical conduction abnormality and heart failure. However, in patient with certain electrical conduction abnormality, a good response is observed in less than 40% in patient receiving CRT. Conventionally the surgical approach of CRT is to implant one pacing lead in the right heart and one in the left heart to resynchronize the contraction and the pacing lead in the left heart is usually placed in the posterior or lateral portion of the left heart. However, this single approach may not be optimal, especially for those patients with conduction abnormality known to have poor response to CRT.

Purpose of the clinical investigation

The purpose of the Electrical Activation Guided CRT Study is to study the effectiveness of a tailored made approach to CRT procedure by using a noninvasive globally mapping system studying the electrical conduction under different approaches to delivery CRT. The pacing approach that optimally corrects conduction abnormality will be determined before the actual implantation procedure.

Conduct of the Investigation

This study will include 93 patients with conduction abnormality that known to have a poor response to CRT from Prince of Wales Hospital, Hong Kong.Subjects will be followed up at 3 months and 6 months visit.

Descripción general del estudio

Estado

Reclutamiento

Descripción detallada

The purpose is to prospectively study the feasibility to optimize configuration of CRT delivery for acute correction of electrical dyssynchrony using a noninvasive mapping of global electrical activation.

Study Hypothesis: Tailor-made configuration of CRT delivery is feasible and able to improve responder rate compare to single method of CRT delivery in candidates with known poor response to CRT.

Primary outcome measure: Responder rate of greater than 10% of LV end systolic volume reduction in patients undergoing tailor-made approach of CRT delivery at 6 months. The responder rate is to compare with pre-defined level of 40% for single method of CRT delivery namely biventricular pacing with LV lead in coronary sinus.

Sample Size: The total required sample size is 93 patients with device implanted.

Tipo de estudio

Intervencionista

Inscripción (Anticipado)

93

Fase

  • No aplica

Contactos y Ubicaciones

Esta sección proporciona los datos de contacto de quienes realizan el estudio e información sobre dónde se lleva a cabo este estudio.

Estudio Contacto

Ubicaciones de estudio

      • Hong Kong, Hong Kong
        • Reclutamiento
        • The Chinese University of Hong Kong
        • Contacto:
        • Sub-Investigador:
          • Joseph YS Chan
        • Investigador principal:
          • Bryan PY Yan
        • Sub-Investigador:
          • Gary CP Chan

Criterios de participación

Los investigadores buscan personas que se ajusten a una determinada descripción, denominada criterio de elegibilidad. Algunos ejemplos de estos criterios son el estado de salud general de una persona o tratamientos previos.

Criterio de elegibilidad

Edades elegibles para estudiar

18 años y mayores (Adulto, Adulto Mayor)

Acepta Voluntarios Saludables

No

Géneros elegibles para el estudio

Todos

Descripción

Inclusion Criteria:

  • Adult (aged 18 or above) of both sexes
  • Ischemic or non-ischemic cause of heart failure
  • QRS duration > 120 ms, non -LBBB type of conduction disturbance
  • NYHA class III or above
  • Sinus rhythm
  • Informed consent by the patient
  • Already received stable dose of guideline directed medical therapy for at least 3 months

Exclusion Criteria:

  • LBBB* patients
  • Pregnant women
  • Participation in another study
  • Patient with contraindication to left ventricle catheterization by a retrograde aortic approach (eg mechanical aortic valve, severe aortic stenosis and aortic dissection) *The definitions of LBBB (QRS duration ≥130 ms; QS or rS in lead V1; broad R waves in leads I, aVL, V5, or V6; and absent q waves in leads I, V5, and V6).

Plan de estudios

Esta sección proporciona detalles del plan de estudio, incluido cómo está diseñado el estudio y qué mide el estudio.

¿Cómo está diseñado el estudio?

Detalles de diseño

  • Propósito principal: Tratamiento
  • Asignación: N / A
  • Modelo Intervencionista: Asignación de un solo grupo
  • Enmascaramiento: Ninguno (etiqueta abierta)

Armas e Intervenciones

Grupo de participantes/brazo
Intervención / Tratamiento
Experimental: Tailor-made CRT delivery
Patient undergoes acute noninvasive electrical dyssynchrony study with various CRT configurations. CRT device is then implanted with optimal configuration.

Ventricular activation maps will be acquired simultaneously with hemodynamic measurements using noninvasive mapping system (ECVUE, Medtronic Inc, USA). A thoracic computed tomographic scan will be acquired with the electrodes attached to the patient. Local ventricular activation times will be defined as the onset of the QRS complex or the pacing spike to the maximal negative slope of each unipolar electrogram.

Pacing leads will be placed in high right atrium, His-bundle region, right ventricular apex, high septal RV, coronary sinus posterior/lateral branch, coronary sinus anterior branch, lateral and septal region of endocardial LV in order to deliver CRT in 8 different configurations.

Otros nombres:
  • Noninvasive electrical activation
  • Electrical Activation Mapping
  • Noninvasive mapping system
  • ECVUE

¿Qué mide el estudio?

Medidas de resultado primarias

Medida de resultado
Medida Descripción
Periodo de tiempo
Responder rate of greater than 10% of LV end systolic volume reduction in patients undergoing tailor-made approach of CRT delivery at 6 months.
Periodo de tiempo: 6 months
Responder rate of greater than 10% of LV end systolic volume reduction measured by echocardiogram comparing baseline and 6 months post implant in patients undergoing tailor-made approach of CRT delivery. Responder rate of greater than 10% of LV end systolic volume reduction measured by echocardiogram comparing baseline and 6 months post implant in patients undergoing tailor-made approach of CRT delivery. The responder rate is to compare with pre-defined level of 40% for single method of CRT delivery namely biventricular pacing with LV lead in coronary sinus.
6 months

Medidas de resultado secundarias

Medida de resultado
Medida Descripción
Periodo de tiempo
The acute electrical dyssynchrony indices of different methods of CRT delivery.
Periodo de tiempo: during procedure
The acute electrical dyssynchrony indices of different methods of CRT delivery.
during procedure
The hemodynamic responses of different methods of CRT delivery.
Periodo de tiempo: during procedure
The hemodynamic responses of different methods of CRT delivery. The hemodynamic response will be maximal dp/dt as measured by pressure wire introduced into the left ventricle during the procedure.
during procedure
Procedure duration of the optimal CRT delivery method
Periodo de tiempo: during procedure
Procedure duration of the optimal CRT delivery method as determined by the best improvement in electrical dyssynchrony indices.
during procedure
Implantation success rate of the optimal CRT delivery method
Periodo de tiempo: during procedure
Implantation success rate of the optimal CRT delivery method as determined by the best improvement in electrical dyssynchrony indices.
during procedure
Cine images (PA, LAO 300, RAO 300) and Chest X ray (PA view)
Periodo de tiempo: during procedure
Cine images (PA, LAO 300, RAO 300) and Chest X ray (PA view)
during procedure
Peri-operative and 6 months follow-up complications rate:
Periodo de tiempo: Peri-operative and 6 months
  1. Thromboembolic event
  2. Dislodgement and migration of pacing leads
  3. Phrenic nerve stimulation
  4. Others
Peri-operative and 6 months
Left ventricular systolic and diastolic volume at baseline and 6 months:
Periodo de tiempo: baseline and 6 months
Echocardiogram parameter of left ventricular systolic and diastolic volume at baseline and 6 months.
baseline and 6 months
Left ventricular ejection fraction at baseline and 6 months:
Periodo de tiempo: baseline and 6 months
Echocardiogram parameter of left ventricular ejection fraction at baseline and 6 months.
baseline and 6 months
Degree of mitral regurgitation at baseline and 6 months:
Periodo de tiempo: baseline and 6 months
Echocardiogram parameter of degree of mitral regurgitation at baseline and 6 months.
baseline and 6 months
Strain imaging at baseline and 6 months:
Periodo de tiempo: baseline and 6 months
Echocardiogram parameter of strain imaging at baseline and 6 months.
baseline and 6 months
NYHA class
Periodo de tiempo: baseline and 6 months
NYHA class at baseline and 6 months.
baseline and 6 months
6 minute hall walk test
Periodo de tiempo: baseline and 6 months
6 minute hall walk test at baseline and 6 months.
baseline and 6 months
Quality of life using Minnesota's questionnaire
Periodo de tiempo: baseline and 6 months
Quality of life using Minnesota's questionnaire at baseline and 6 months.
baseline and 6 months
Electrical parameters including threshold, sensitivity and lead impedance of pacing leads at implant and 6 months follow-up.
Periodo de tiempo: during procedure and 6 months
Electrical parameters including threshold, sensitivity and lead impedance of pacing leads at implant and 6 months follow-up.
during procedure and 6 months

Colaboradores e Investigadores

Aquí es donde encontrará personas y organizaciones involucradas en este estudio.

Investigadores

  • Investigador principal: Bryan PY YAN, Chinese University of Hong Kong

Publicaciones y enlaces útiles

La persona responsable de ingresar información sobre el estudio proporciona voluntariamente estas publicaciones. Estos pueden ser sobre cualquier cosa relacionada con el estudio.

Publicaciones Generales

Fechas de registro del estudio

Estas fechas rastrean el progreso del registro del estudio y los envíos de resultados resumidos a ClinicalTrials.gov. Los registros del estudio y los resultados informados son revisados ​​por la Biblioteca Nacional de Medicina (NLM) para asegurarse de que cumplan con los estándares de control de calidad específicos antes de publicarlos en el sitio web público.

Fechas importantes del estudio

Inicio del estudio (Actual)

8 de marzo de 2018

Finalización primaria (Anticipado)

31 de agosto de 2024

Finalización del estudio (Anticipado)

31 de agosto de 2024

Fechas de registro del estudio

Enviado por primera vez

8 de noviembre de 2017

Primero enviado que cumplió con los criterios de control de calidad

23 de noviembre de 2017

Publicado por primera vez (Actual)

29 de noviembre de 2017

Actualizaciones de registros de estudio

Última actualización publicada (Actual)

19 de octubre de 2021

Última actualización enviada que cumplió con los criterios de control de calidad

18 de octubre de 2021

Última verificación

1 de octubre de 2021

Más información

Términos relacionados con este estudio

Otros números de identificación del estudio

  • CUHK-MAPCRT-1

Plan de datos de participantes individuales (IPD)

¿Planea compartir datos de participantes individuales (IPD)?

No

Información sobre medicamentos y dispositivos, documentos del estudio

Estudia un producto farmacéutico regulado por la FDA de EE. UU.

No

Estudia un producto de dispositivo regulado por la FDA de EE. UU.

No

Esta información se obtuvo directamente del sitio web clinicaltrials.gov sin cambios. Si tiene alguna solicitud para cambiar, eliminar o actualizar los detalles de su estudio, comuníquese con register@clinicaltrials.gov. Tan pronto como se implemente un cambio en clinicaltrials.gov, también se actualizará automáticamente en nuestro sitio web. .

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