Cardiac Arrhythmias Clinical Trial
Official title:
Correlations Between Arrhythmias, Climatic Variables and Air Pollution in Patients With Pacemaker and ICD, Followed by Remote Monitoring.
It is a clinical, observational study to evaluate the correlations among arrhythmias,
climatic variables and air pollution in patients with pacemaker and implantable
defibrillator (ICD), followed by remote monitoring.
Purpose of the Study: The purpose of this study is to test the hypothesis that changes in
climatic variables, such as temperature, pressure and humidity, and changes of particulate
matter <10µ (PM10), particulate matter <2.5µ (PM2.5), ozone (O3), carbon monoxide (CO),
sulfur dioxide (SO2), nitrogen dioxide (NO2), are associated with an increase of
supraventricular and ventricular arrhythmias.
Objectives: The aim of this study is to determine whether changes in variables conditions
affect the electrical stability of the myocardium in patients with pacemakers and ICDs.
Population: male and female subjects, aged ≥ 18 years, implanted by a dual-chamber
pacemaker, ICD or biventricular ICD (ICD-CRT). A total of 500 subjects from 15 cardiology
centers of the Veneto region will be included.
The primary objectives of this study are as follows:
- Determine if the changes of temperature, pressure and humidity, are associated with an
increase of atrial and ventricular arrhythmias.
- Determine if the changes of air pollution (gas and particulate), are associated with an
increase of atrial and ventricular arrhythmias.
The secondary objectives of the study are:
- Determine if the changes of air pollution (gas and particulate), are associated with
significant changes in mean heart rate, rate variability rate and the percentage of
paced beats.
- Determine whether changes in temperature, pressure or humidity, are associated with
significant changes in mean heart rate, heart rate variability and the percentage of
paced beats.
- Determine if the changes of temperature, pressure and humidity, are associated with an
increase in mortality or hospitalization for myocardial infarction or congestive heart
failure.
- Determine if the changes of air pollution (gas and particulate), are associated with an
increase in mortality or hospitalization for myocardial infarction or congestive heart
failure.
Study Design This is a prospective, observational study, which compares the occurrence of
atrial and ventricular arrhythmias and changes in physiological parameters, with climatic
variables and air pollution.
The study will include 500 subjects and will consist of two periods:
Screening: we will collect baseline characteristics of subjects in the clinical examination.
The period recruitment will run for 12 months.
Follow-up: After written informed consent will be signed, subjects who meet the criteria for
inclusion will be enrolled in the study and followed up for a minimum period of 12 months.
The data obtained from the remote monitoring will be evaluated for the daily values provided
for the parameters considered in the study.
Periodical visits in pacemaker clinic will be scheduled at the discretion of the referring
cardiologist of the center. The arrhythmic events that will occur in this period, detected
by means of remote monitoring or through other clinical evaluations will be recorded. Atrial
arrythmias: atrial fibrillation or atrial flutter, supraventricular tachycardia.
Ventricular arrhythmias: ventricular tachycardia, ventricular fibrillation, ventricular
extrasystoles.
Physiological variables: average heart rate (24 hours and at rest), heart rate variability,
the percentage of paced beats.
In addition, any changes in drug therapies and all clinically relevant events, will be
recorded.
During the same period data from monitoring stations of ARPAV (Regional Agency for
Environmental Prevention and Protection of Veneto Region) will be collected.
Climatic variables: temperature, humidity, atmospheric pressure. Parameters of air
pollution: PM10, PM2.5, O3, CO, SO2, NO2. For each patient, the data from the monitoring
station ARPAV of the urban area of residence of the subject will be considered. The mean
exposure level used in the analytical studies on the health effects is calculated on the
average number of units active in the area. This number is usually of 2-3 units in large
centers, while it is generally only 1 in small towns. The residents in centers without
monitoring will be excluded from the study. The mean value is the best approximation ... to
be continued page 6.
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Observational Model: Cohort, Time Perspective: Prospective
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