Electrical Activation Mapping Guided Tailor Made Approach for Cardiac Resynchronization Therapy
2021년 10월 18일 업데이트: 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.
연구 개요
상세 설명
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.
연구 유형
중재적
등록 (예상)
93
단계
- 해당 없음
연락처 및 위치
이 섹션에서는 연구를 수행하는 사람들의 연락처 정보와 이 연구가 수행되는 장소에 대한 정보를 제공합니다.
연구 연락처
- 이름: Olivia TO
- 전화번호: (852) 3505 1750
- 이메일: oliviato@cuhk.edu.hk
연구 장소
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Hong Kong, 홍콩
- 모병
- The Chinese University of Hong Kong
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연락하다:
- Olivia To
- 전화번호: (852) 35051750
- 이메일: oliviato@cuhk.edu.hk
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부수사관:
- Joseph YS Chan
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수석 연구원:
- Bryan PY Yan
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부수사관:
- Gary CP Chan
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참여기준
연구원은 적격성 기준이라는 특정 설명에 맞는 사람을 찾습니다. 이러한 기준의 몇 가지 예는 개인의 일반적인 건강 상태 또는 이전 치료입니다.
자격 기준
공부할 수 있는 나이
18년 이상 (성인, 고령자)
건강한 자원 봉사자를 받아들입니다
아니
연구 대상 성별
모두
설명
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).
공부 계획
이 섹션에서는 연구 설계 방법과 연구가 측정하는 내용을 포함하여 연구 계획에 대한 세부 정보를 제공합니다.
연구는 어떻게 설계됩니까?
디자인 세부사항
- 주 목적: 치료
- 할당: 해당 없음
- 중재 모델: 단일 그룹 할당
- 마스킹: 없음(오픈 라벨)
무기와 개입
참가자 그룹 / 팔 |
개입 / 치료 |
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실험적: 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.
다른 이름들:
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연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
측정값 설명 |
기간 |
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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.
기간: 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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2차 결과 측정
결과 측정 |
측정값 설명 |
기간 |
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The acute electrical dyssynchrony indices of different methods of CRT delivery.
기간: 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.
기간: 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
기간: 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
기간: 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)
기간: 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:
기간: 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:
기간: 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:
기간: 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:
기간: 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:
기간: 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
기간: 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
기간: 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
기간: 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.
기간: 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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공동 작업자 및 조사자
여기에서 이 연구와 관련된 사람과 조직을 찾을 수 있습니다.
수사관
- 수석 연구원: Bryan PY YAN, Chinese University of Hong Kong
간행물 및 유용한 링크
연구에 대한 정보 입력을 담당하는 사람이 자발적으로 이러한 간행물을 제공합니다. 이것은 연구와 관련된 모든 것에 관한 것일 수 있습니다.
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- Yu CM, Zhang Q, Yip GW, Chan YS, Lee PW, Wu LW, Lam YY, Kum LC, Chan HC, Chan S, Fung JW. Are left ventricular diastolic function and diastolic asynchrony important determinants of response to cardiac resynchronization therapy? Am J Cardiol. 2006 Oct 15;98(8):1083-7. doi: 10.1016/j.amjcard.2006.05.028. Epub 2006 Aug 30.
- Fung JW, Zhang Q, Yip GW, Chan JY, Chan HC, Yu CM. Effect of cardiac resynchronization therapy in patients with moderate left ventricular systolic dysfunction and wide QRS complex: a prospective study. J Cardiovasc Electrophysiol. 2006 Dec;17(12):1288-92. doi: 10.1111/j.1540-8167.2006.00612.x. Epub 2006 Sep 20.
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연구 기록 날짜
이 날짜는 ClinicalTrials.gov에 대한 연구 기록 및 요약 결과 제출의 진행 상황을 추적합니다. 연구 기록 및 보고된 결과는 공개 웹사이트에 게시되기 전에 특정 품질 관리 기준을 충족하는지 확인하기 위해 국립 의학 도서관(NLM)에서 검토합니다.
연구 주요 날짜
연구 시작 (실제)
2018년 3월 8일
기본 완료 (예상)
2024년 8월 31일
연구 완료 (예상)
2024년 8월 31일
연구 등록 날짜
최초 제출
2017년 11월 8일
QC 기준을 충족하는 최초 제출
2017년 11월 23일
처음 게시됨 (실제)
2017년 11월 29일
연구 기록 업데이트
마지막 업데이트 게시됨 (실제)
2021년 10월 19일
QC 기준을 충족하는 마지막 업데이트 제출
2021년 10월 18일
마지막으로 확인됨
2021년 10월 1일
추가 정보
이 연구와 관련된 용어
기타 연구 ID 번호
- CUHK-MAPCRT-1
개별 참가자 데이터(IPD) 계획
개별 참가자 데이터(IPD)를 공유할 계획입니까?
아니
약물 및 장치 정보, 연구 문서
미국 FDA 규제 의약품 연구
아니
미국 FDA 규제 기기 제품 연구
아니
이 정보는 변경 없이 clinicaltrials.gov 웹사이트에서 직접 가져온 것입니다. 귀하의 연구 세부 정보를 변경, 제거 또는 업데이트하도록 요청하는 경우 register@clinicaltrials.gov. 문의하십시오. 변경 사항이 clinicaltrials.gov에 구현되는 즉시 저희 웹사이트에도 자동으로 업데이트됩니다. .
심부전에 대한 임상 시험
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Medical University of BialystokInstitute of Cardiology, Warsaw, Poland; Medical University of Lodz; Poznan University of... 그리고 다른 협력자들아직 모집하지 않음심부전, 수축기 | 박출률이 감소된 심부전 | 심부전 New York Heart Association Class IV | 심부전 New York Heart Association Class III폴란드
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Novartis Pharmaceuticals완전한핵심 연구의 12개월 치료 기간을 성공적으로 완료한 환자(de Novo Heart Recipients)는 EC-MPS 치료에 관심이 있었습니다.
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University of WashingtonAmerican Heart Association완전한심부전，울혈 | 미토콘드리아 변경 | 심부전 New York Heart Association Class IV미국