Chronotropic Incompetence Clinical Trial
— RAPOfficial title:
Comparison of Physiologic Response With Rate Adaptive Pacing Driven by Minute Ventilation and Accelerometer
Some patients' heart rates do not increase as needed during activities and exercise, which can make them feel tired and fatigued easily. The patients in this study have a pacemaker with a FDA approved rate response sensor, which senses activity level by sensing motion (through a component known as an accelerometer) and/or breathing changes (known as minute ventilation). These changes in motion or breathing make the pacemaker increase the patient's heart rate. This study is being conducted to see which rate response sensor is better (motion driven or breathing driven). The study is also investigating whether optimizing the sensor based on the individual patient will give better results in terms of increasing the patient's exercise capacity. The hypothesis is that rate responsive pacing driven by the minute ventilation sensor results in improved functional capacity compared to accelerometer in chronotropically incompetent patients.
Status | Recruiting |
Enrollment | 100 |
Est. completion date | June 2014 |
Est. primary completion date | June 2014 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 18 Years and older |
Eligibility |
Inclusion Criteria: - Willing and capable of providing informed consent for participation - Previously received, or previously scheduled to receive, dual-chamber/single chamber pacemaker with active atrial and ventricular leads.Boston Scientific Ingenio K172, K173, K174; or (both Ingenio and Advantio have similar rate response features) Advantio K062, K063, K064 (Boston Scientific CRM, St. Paul, MN). - Plans to remain in the long-term care of his/her enrolling physician and is available for study follow-up for three months post-enrollment - Patients with or without one or more of the following are permitted to enroll: - Sinus node dysfunction with pacemaker - Mobitz II second degree heart block or third degree heart block with pacemaker - Chronic atrial fibrillation and other atrial arrhythmias with controlled heart rate within the past 90 days prior to consent - Paroxysmal atrial fibrillation on rate controlling medication as long as same rhythm stays throughout the study, sinus or atrial fibrillation. - Patients with pacemakers requiring beta blocker (or other rate limiting medications) therapy Exclusion Criteria: - Neuromuscular, orthopedic, or vascular disability that prevents normal walking (e.g., intermittent claudication, arthritis, residual stroke weakness, need for a wheelchair or walker) - A symptom-limited exercise protocol is thought to be dangerous or contra-indicated, including but not limited to changing pattern of chest discomfort, unstable angina or uncontrolled arrhythmias Severe pulmonary disease with inability to exercise - Severe heart failure with dyspnea at rest and inability to exercise (NYHA class IV) and qualify for the CRT-D - Life expectancy is less than 12 months due to other medical conditions, per physician discretion - Has or indicated for an implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D) - Currently, or within 30 days prior to consent, enrolled in another investigational study that would directly impact the treatment or outcome of the current study. - Younger than 18 years of age - Patients with pacemakers of unipolar atrial or ventricular lead configuration - Patients with abdominal pacemaker implants - Patients on a ventilator - Patients with a pacemaker with epicardial lead - Patients with Pneumothorax, pericardial effusion or pleural effusion - Pregnant or planning to become pregnant during the study (method of assessment upon physician's discretion). Pregnancy test will be done for all female patients of childbearing age before the study, and at each visit. - Unable or unwilling to comply with the protocol requirements |
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Crossover Assignment, Masking: Double Blind (Subject, Investigator, Outcomes Assessor), Primary Purpose: Treatment
Country | Name | City | State |
---|---|---|---|
United States | Albany Medical College | Albany | New York |
Lead Sponsor | Collaborator |
---|---|
Albany Medical College | Boston Scientific Corporation |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Metabolic chronotropic relationship (MCR) slope | Improvement in functional capacity, determined by MCR slope - if greater using the minute ventilation senor of the accelerometer sensor in patients with chronotropic incompetence | 2 weeks, 6 weeks, and 10 weeks post-implant/post enrollment | No |
Secondary | Changes in heart rate and distance covered during 6-minute walk test | To evaluate the superiority of the minute ventilation sensor or the accelerometer sensor by comparing changes in heart rate and distance covered during activities using a 6 minute walk test. | 2 weeks, 6 and 10 weeks post-implant/post enrollment | No |
Secondary | Exercise time during chronotropic assessment exercise protocol (CAEP) stress test | To evaluate the superiority of the minute ventilation sensor or the accelerometer sensor related to exercise time during the CAEP stress test | 2 weeks, 6 and 10 weeks post-implant/post enrollment | No |
Secondary | Quality of life (QOL) assessment | SF-36 questionnaire and Aquarel questionnaire to assess quality of life | 2 weeks, 6 and 10 weeks post-implant/post enrollment | No |
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