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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT02624765
Other study ID # 1000039945
Secondary ID
Status Completed
Phase Phase 3
First received
Last updated
Start date February 2016
Est. completion date March 31, 2024

Study information

Verified date May 2024
Source The Hospital for Sick Children
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The Fetal Atrial Flutter and Supraventricular Tachycardia (FAST) Therapy Trial is a prospective multi-center trial that examines the efficacy and safety of standard prenatal antiarrhythmic treatment. Study components of FAST include three prospective sub-studies to determine the efficacy and safety of commonly used transplacental drug regimens in suppressing fetal AF without hydrops (Randomized Clinical Trial (RCT) A), SVT without hydrops (RCT B), and SVT with hydrops (RCT C). All RCTs are open label phase III trials of standard 1st line therapy, which either is started as monotherapy (no hydrops) or as dual therapy (hydrops).


Description:

Few studies are specifically designed to address health concerns relevant during pregnancy. The consequence is a lack of evidence on best clinical practice. This includes mothers and their babies when pregnancy is complicated by an abnormally fast heart rate up to 300 beats per minute due to supraventricular tachyarrhythmia (SVA) in the unborn baby (fetus). Although fetal SVA, including atrial flutter (AF) and other forms of supraventricular tachycardia (SVT), is the most common cause of intended in-utero fetal therapy, none of the medication used to date has been evaluated for their effects on the mother and her baby in a randomized controlled trial (RCT). As a consequence, physicians need to make decisions about the management of such pregnancies without any evidence from controlled trials on drug efficacy and safety and no consensus among specialists for the optimal management. The Fetal Atrial Flutter and Supraventricular Tachycardia (FAST) Therapy Trial is a prospective multi-center trial that addresses this knowledge gap to guide future fetal SVA therapy to the best of care. Study components of FAST include three prospective sub-studies to determine the efficacy and safety of commonly used transplacental drug regimens in suppressing fetal AF without hydrops (RCT A), SVT without hydrops (RCT B), and SVT with hydrops (RCT C). All RCTs are open label phase III trials of standard 1st line therapy, which either is started as monotherapy (no hydrops) or as dual therapy (hydrops). The primary study aim is the probability of a normal pregnancy outcome after treatment start with Digoxin or Sotalol (AF without hydrops); Digoxin or Flecainide (SVT without hydrops); and Digoxin plus Sotalol or Digoxin plus Flecainide (SVT with hydrops).


Recruitment information / eligibility

Status Completed
Enrollment 105
Est. completion date March 31, 2024
Est. primary completion date March 31, 2024
Accepts healthy volunteers No
Gender Female
Age group 16 Years to 50 Years
Eligibility Inclusion Criteria: 1. Mother has provided written informed consent to participate 2. Either fetal AF without hydrops, SVT without hydrops or SVT with hydrops 3. Tachyarrhythmia that is significant enough to justify immediate transplacental pharmacological treatment: - Tachycardia = 180 bpm during at least 10% of observation time of 30 minutes or longer - Tachycardia = 170 bpm during +100% of time (= 30 0/7 weeks of gestation) - Tachycardia = 280 bpm (irrespective of SVA duration) - SVT with fetal hydrops (irrespective of duration) 4. Gestational age > 12 0/7 weeks and <36 0/7 weeks at time of enrollment 5. Untreated tachycardia at time of enrollment 6. Singleton Pregnancy 7. Healthy mother with ± normal pre-treatment cardiovascular findings: - ECG without significant abnormalities (sinus rhythm; QTc = 0.47; PR = 0.2 sec; QRS: = 0.12 sec; isolated PACs or PVCs or isolated complete right bundle branch block allowed) - Resting heart rate = 50 bpm - Systolic BP = 85 bpm Exclusion Criteria: 1. AF with hydrops (eligible for FAST Registry only) 2. Any maternal-fetal conditions associated with high odds of premature delivery or death other than tachycardia (e.g. severe IUGR; premature rupture of membrane; life-threatening maternal disease (incl. pre-eclampsia; HELLP syndrome); severe congenital fetal abnormalities (T 13 or 18; surgery or death expected < 1 month) 3. History of significant maternal heart condition (open heart surgery; sick sinus syndrome; channelopathy (long QT, Brugada syndrome); ventricular tachycardia; WPW syndrome; high-degree heart block; cardiomyopathy) 4. Relevant preexisting maternal obstructive airway disease including asthma 5. Current therapy with the following medications: - Antiarrhythmic drugs - Pentamidine 6. Maternal serum potassium level <3.3 mmol/L / <3.3 mEq/L (at start of treatment) 7. Maternal ionized serum calcium level of <1 mmol/L / <4 mg/dL) or total serum calcium level <2 mmol/L / <8mg/dL (at start of treatment) 8. Maternal serum creatinine level > 97.2 µmol/L (>1.1 mg/dl)

Study Design


Related Conditions & MeSH terms


Intervention

Drug:
Digoxin (monotherapy)
Oral or IV loading dose: 0.5 mg q 12 h (total 4 doses over 48 hours) followed by Oral maintenance dose: 0.25 mg-1mg/day
Sotalol (monotherapy)
Oral dose: 80 mg TID or 120 mg BID (240 mg/day)
Flecainide (monotherapy)
Oral dose: 100 mg TID (300 mg/day)
Digoxin (dual therapy)
Oral or IV loading dose: 0.5 mg q 8 h (total 4 doses over 32 hours) followed by oral maintenance dose: 0.25 mg-1mg/day
Sotalol (dual therapy)
Oral dose: 160 mg BID (320 mg/day)
Flecainide (dual therapy)
Oral dose:100 mg TID (300 mg/day)

Locations

Country Name City State
Australia The Royal Women's Hospital Melbourne Victoria
Canada University of Alberta/WCCHN Edmonton Alberta
Canada CHU Sainte-Justine Hospital Montreal Quebec
Canada Mount Sinai Hospital Toronto Ontario
Canada The Hospital for Sick Children Toronto Ontario
Canada British Columbia Children's Hospital Vancouver British Columbia
Germany UKB Universitätsklinikum BONN Bonn
Netherlands Academic Medical Center - AMC Amsterdam
Netherlands Leiden University Medical Center - LUMC Leiden
United Kingdom St George's University Hospital Foundation Trust London
United States Children's Hospital of Colorado Aurora Colorado
United States Pediatrix Medical Services, Inc, Austin Texas
United States Cincinnati Children's Hospital Medical Center Cincinnati Ohio
United States Baylor College of Medicine Houston Texas
United States Children's Hospital of Wisconsin Milwaukee Wisconsin
United States West Virginia University Research Corporation Morgantown West Virginia
United States Vanderbilt University Medical Center Nashville Tennessee
United States Cohen Children's Medical Center New York New York
United States Morgan Stanley Children's Hospital of New York-Presbyterian New York New York
United States University of Utah Salt Lake City Utah
United States UCSF Benioff Children's Hospital San Francisco California
United States Children's National Health System Washington District of Columbia

Sponsors (2)

Lead Sponsor Collaborator
Edgar Jaeggi Canadian Institutes of Health Research (CIHR)

Countries where clinical trial is conducted

United States,  Australia,  Canada,  Germany,  Netherlands,  United Kingdom, 

Outcome

Type Measure Description Time frame Safety issue
Primary Proportion of live-born children with a delivery at term and a normal cardiac rhythm Term delivery (=37 0/7 weeks gestation) with a normal cardiac rhythm (ECG). Term: 37 0/7 to 41 6/7 weeks
Secondary Proportion of patients with cardioversion over time Number of participants with persistent tachycardia compared to number of participants with cardioversion to a normal rhythm over time From date of randomization until the date of first documented cardioversion or until the date of delivery/fetal death without cardioversion, whichever comes first, assessed up to 30 gestational weeks
Secondary Proportion of participants with treatment failure Number of participants with treatment failure compared to number of participants with successful treatment. Treatment failure is defined as one of the following: 1) cross-over to another drug; 2) SVT/AF that persists to birth; 3) preterm birth; 4) death. From date of randomization until the date of first documented fetal cardioversion or until the date of treatment failure, whichever comes first, assessed up to 30 gestational weeks
Secondary Proportion of participants with arrhythmia-related death Number of participants with arrhythmia-related death compared to other outcomes From date of randomization to 30 days of life
Secondary Average gestational age at birth Mean of the gestational age at birth At birth
Secondary Birth weight z-scores A birth weight z-score compares a child's birth weight to the weight of a child of the same length/height and gender to classify nutritional status At birth
Secondary Total days of treatment related maternal and neonatal hospitalizations Average days of maternal and neonatal hospitalization related to SVA therapy From date of randomization to 30 days of life
Secondary Maternal prevalence of adverse events and outcome Maternal prevalence of pregnancy/treatment-related AEs and outcomes From date of randomization to 30 days of life