Electrical Activation Mapping Guided Tailor Made Approach for Cardiac Resynchronization Therapy
maanantai 18. lokakuuta 2021 päivittänyt: 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.
Tutkimuksen yleiskatsaus
Tila
Rekrytointi
Ehdot
Interventio / Hoito
Yksityiskohtainen kuvaus
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.
Opintotyyppi
Interventio
Ilmoittautuminen (Odotettu)
93
Vaihe
- Ei sovellettavissa
Yhteystiedot ja paikat
Tässä osiossa on tutkimuksen suorittajien yhteystiedot ja tiedot siitä, missä tämä tutkimus suoritetaan.
Opiskeluyhteys
- Nimi: Olivia TO
- Puhelinnumero: (852) 3505 1750
- Sähköposti: oliviato@cuhk.edu.hk
Opiskelupaikat
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Hong Kong, Hong Kong
- Rekrytointi
- The Chinese University of Hong Kong
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Ottaa yhteyttä:
- Olivia To
- Puhelinnumero: (852) 35051750
- Sähköposti: oliviato@cuhk.edu.hk
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Alatutkija:
- Joseph YS Chan
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Päätutkija:
- Bryan PY Yan
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Alatutkija:
- Gary CP Chan
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Osallistumiskriteerit
Tutkijat etsivät ihmisiä, jotka sopivat tiettyyn kuvaukseen, jota kutsutaan kelpoisuuskriteereiksi. Joitakin esimerkkejä näistä kriteereistä ovat henkilön yleinen terveydentila tai aiemmat hoidot.
Kelpoisuusvaatimukset
Opintokelpoiset iät
18 vuotta ja vanhemmat (Aikuinen, Vanhempi Aikuinen)
Hyväksyy terveitä vapaaehtoisia
Ei
Sukupuolet, jotka voivat opiskella
Kaikki
Kuvaus
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).
Opintosuunnitelma
Tässä osiossa on tietoja tutkimussuunnitelmasta, mukaan lukien kuinka tutkimus on suunniteltu ja mitä tutkimuksella mitataan.
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
- Ensisijainen käyttötarkoitus: Hoito
- Jako: Ei käytössä
- Inventiomalli: Yksittäinen ryhmätehtävä
- Naamiointi: Ei mitään (avoin tarra)
Aseet ja interventiot
Osallistujaryhmä / Arm |
Interventio / Hoito |
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Kokeellinen: Tailor-made CRT delivery
Patient undergoes acute noninvasive electrical dyssynchrony study with various CRT configurations.
CRT device is then implanted with optimal configuration.
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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.
Muut nimet:
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Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
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Responder rate of greater than 10% of LV end systolic volume reduction in patients undergoing tailor-made approach of CRT delivery at 6 months.
Aikaikkuna: 6 months
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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.
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6 months
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Toissijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
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The acute electrical dyssynchrony indices of different methods of CRT delivery.
Aikaikkuna: during procedure
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The acute electrical dyssynchrony indices of different methods of CRT delivery.
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during procedure
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The hemodynamic responses of different methods of CRT delivery.
Aikaikkuna: during procedure
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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.
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during procedure
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Procedure duration of the optimal CRT delivery method
Aikaikkuna: during procedure
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Procedure duration of the optimal CRT delivery method as determined by the best improvement in electrical dyssynchrony indices.
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during procedure
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Implantation success rate of the optimal CRT delivery method
Aikaikkuna: during procedure
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Implantation success rate of the optimal CRT delivery method as determined by the best improvement in electrical dyssynchrony indices.
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during procedure
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Cine images (PA, LAO 300, RAO 300) and Chest X ray (PA view)
Aikaikkuna: during procedure
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Cine images (PA, LAO 300, RAO 300) and Chest X ray (PA view)
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during procedure
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Peri-operative and 6 months follow-up complications rate:
Aikaikkuna: Peri-operative and 6 months
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Peri-operative and 6 months
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Left ventricular systolic and diastolic volume at baseline and 6 months:
Aikaikkuna: baseline and 6 months
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Echocardiogram parameter of left ventricular systolic and diastolic volume at baseline and 6 months.
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baseline and 6 months
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Left ventricular ejection fraction at baseline and 6 months:
Aikaikkuna: baseline and 6 months
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Echocardiogram parameter of left ventricular ejection fraction at baseline and 6 months.
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baseline and 6 months
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Degree of mitral regurgitation at baseline and 6 months:
Aikaikkuna: baseline and 6 months
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Echocardiogram parameter of degree of mitral regurgitation at baseline and 6 months.
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baseline and 6 months
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Strain imaging at baseline and 6 months:
Aikaikkuna: baseline and 6 months
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Echocardiogram parameter of strain imaging at baseline and 6 months.
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baseline and 6 months
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NYHA class
Aikaikkuna: baseline and 6 months
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NYHA class at baseline and 6 months.
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baseline and 6 months
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6 minute hall walk test
Aikaikkuna: baseline and 6 months
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6 minute hall walk test at baseline and 6 months.
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baseline and 6 months
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Quality of life using Minnesota's questionnaire
Aikaikkuna: baseline and 6 months
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Quality of life using Minnesota's questionnaire at baseline and 6 months.
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baseline and 6 months
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Electrical parameters including threshold, sensitivity and lead impedance of pacing leads at implant and 6 months follow-up.
Aikaikkuna: during procedure and 6 months
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Electrical parameters including threshold, sensitivity and lead impedance of pacing leads at implant and 6 months follow-up.
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during procedure and 6 months
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Yhteistyökumppanit ja tutkijat
Täältä löydät tähän tutkimukseen osallistuvat ihmiset ja organisaatiot.
Sponsori
Tutkijat
- Päätutkija: Bryan PY YAN, Chinese University of Hong Kong
Julkaisuja ja hyödyllisiä linkkejä
Tutkimusta koskevien tietojen syöttämisestä vastaava henkilö toimittaa nämä julkaisut vapaaehtoisesti. Nämä voivat koskea mitä tahansa tutkimukseen liittyvää.
Yleiset julkaisut
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Opintojen ennätyspäivät
Nämä päivämäärät seuraavat ClinicalTrials.gov-sivustolle lähetettyjen tutkimustietueiden ja yhteenvetojen edistymistä. National Library of Medicine (NLM) tarkistaa tutkimustiedot ja raportoidut tulokset varmistaakseen, että ne täyttävät tietyt laadunvalvontastandardit, ennen kuin ne julkaistaan julkisella verkkosivustolla.
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Tutkimustietojen päivitykset
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Viimeksi vahvistettu
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Lisää tietoa
Tähän tutkimukseen liittyvät termit
Avainsanat
Muita asiaankuuluvia MeSH-ehtoja
Muut tutkimustunnusnumerot
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Yksittäisten osallistujien tietojen suunnitelma (IPD)
Aiotko jakaa yksittäisten osallistujien tietoja (IPD)?
Ei
Lääke- ja laitetiedot, tutkimusasiakirjat
Tutkii yhdysvaltalaista FDA sääntelemää lääkevalmistetta
Ei
Tutkii yhdysvaltalaista FDA sääntelemää laitetuotetta
Ei
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