Hypertrophic Cardiomyopathy Clinical Trial
— EMORI-HCMOfficial title:
Mechanisms and Innovations in Right Ventricular Pacing For Hypertrophic Obstructive Cardiomyopathy
Hypertrophic Obstructive Cardiomyopathy (HOCM) is an inherited cardiac condition which causes the heart muscle to become abnormally thick causing obstruction of blood flow in the heart. This causes debilitating symptoms including shortness of breath, blackouts and chest pain. Current treatments are not ideal as the medication is often poorly tolerated or ineffective. People with HOCM can often have an Implantable Cardioverter Defibrillator (ICD) to shock them out of dangerous arrhythmias. ICD's can also be used as pacemakers and are a promising treatment option, since they can alter the sequence of the heart muscle contraction thereby relieving the obstruction to the blood flow, making it easier for the heart to pump. The study will recruit patients who already have an ICD/pacemaker or who are scheduled to have an ICD / pacemaker implanted. For patients who are due to have a device implanted high precision haemodynamic, echocardiographic and electrical measurement techniques will be used to assess whether adjusting the position of the pacing lead (at the time of implant) can bring about changes in LVOT gradient and blood pressure. These patients with a new device and also patients who already have a device in situ will then go on to have atrioventricular delay (AV Delay) optimisation so we can assess what the optimum AV delay should be programmed at in order to bring about the most improvement in LVOT gradient and blood pressure. Patients will then be recruited into a medium term double blinded randomised crossover study. They will have optimum RV pacing settings turned on for 3 months. They will then return and be crossed over and have optimum RV pacing turned off for a further 3 months. The primary outcome will be to see if optimum RV pacing being turned on is effective in improving symptoms and quality of life.
Status | Recruiting |
Enrollment | 60 |
Est. completion date | October 1, 2025 |
Est. primary completion date | October 1, 2025 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years to 100 Years |
Eligibility | Inclusion criteria: - All patients will have a clinical diagnosis of HOCM with an LVOT gradient of at least 30 mmHg, at rest or provoked. - Symptomatic patients - Can have co-existing mid-cavity obstruction. - HOCM patients referred for Dual Chamber Pacemaker / ICD Implantation. - Adults willing to take part (ages 18 - 100 years old) - Able to give consent. Exclusion criteria: - Unable to give consent - Children age < 18 years or adults > 100 years old - Pregnant patient - Patients with persistent Atrial Fibrillation or high grade Atrio-Ventricular Block |
Country | Name | City | State |
---|---|---|---|
United Kingdom | National Heart & Lung Institute, Imperial College London | London |
Lead Sponsor | Collaborator |
---|---|
Imperial College London | British Heart Foundation |
United Kingdom,
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Kyriacou A, Pabari PA, Whinnett ZI, Arri S, Willson K, Baruah R, Stegemann B, Mayet J, Kanagaratnam P, Hughes AD, Francis DP. Fully automatable, reproducible, noninvasive simple plethysmographic optimization: proof of concept and potential for implantability. Pacing Clin Electrophysiol. 2012 Aug;35(8):948-60. doi: 10.1111/j.1540-8159.2012.03435.x. Epub 2012 Jul 2. — View Citation
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Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Patient symptoms | Patient symptoms via patient questionnaire - Kansas City Cardiomyopathy Questionnaire. All Kansas City Cardiomyopathy Questionnaire scores are scaled from 0 to 100 and frequently summarized in 25-point ranges, where scores represent health status as follows: 0 to 24: very poor to poor; 25 to 49: poor to fair; 50 to 74: fair to good; and 75 to 100: good to excellent | 6 months | |
Secondary | Exercise Capacity | Change in exercise capacity by 6 Minute Walk Test | 6 months | |
Secondary | Exercise Capacity | Change in exercise capacity by Cardiopulmonary Exercise Testing (MVOT) | 6 months | |
Secondary | BNP | Change in BNP - Brain Natriuretic Peptide (blood test) | 6 months | |
Secondary | Patient preference of optimum pacing on or pacing off | An exploratory secondary outcome - patients will be asked at the end of the study which 3 month period they preferred (they will not be told during which 3 month period they were paced and not paced when they answer this question). | 6 months | |
Secondary | Patient symptoms | Patient symptoms via patient questionnaire - EQ-5D-5L Questionnaire. EQ-5D-5L health states can be summarised using the 5-digit code or represented by a single summary number (index value), which reflects how good or bad a health state is according to the preferences of the general population of a country/region. Most EQ-5D value sets have been obtained from a standardised valuation exercise, in which a representative sample of the general population in a country/region is asked to place a value on EQ-5D health states. | 6 months | |
Secondary | Patient symptoms | Patient symptoms via a smartphone daily symptom application | 6 months | |
Secondary | Echo Parameters | Change in LV Ejection Fraction (measured by Simpson's Biplane %) | 6 months | |
Secondary | Echo Parameters | Change in resting and peak exertion LVOT gradients (measured by Echo in mm Hg) | 6 months | |
Secondary | Pacemaker / ICD Activity Data | The pacemaker / device will be interrogated to give us information about participants activity levels (hrs per day) | 6 months |
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