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Clinical Trial Details — Status: Terminated

Administrative data

NCT number NCT02757976
Other study ID # 252410
Secondary ID
Status Terminated
Phase N/A
First received
Last updated
Start date March 8, 2018
Est. completion date June 20, 2019

Study information

Verified date September 2020
Source Lawson Health Research Institute
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

This trial will compare two strategies for patients with Heart Failure, Left Ventricular systolic dysfunction, and intermediate QRS durations. The control group is conventional CRT. The experimental group is LVendo CRT


Description:

Patients randomized to the Conventional CRT will receive a CRT device with or without ICD. Device implantation will be performed within 10 working days of randomization.

Patients randomized to LV endocardial CRT will receive a CRT device with or without ICD, placed in the same time frame and will have RA and RV leads implanted as the conventional CRT group. The device will be implanted in a facility that has the capacity to perform trans-atrial septal puncture with ultrasound guidance. The LV lead will be placed using a trans-atrial septal approach using a specially designed puncture tools and LVendo delivery tool kits specifically designed for this study


Recruitment information / eligibility

Status Terminated
Enrollment 8
Est. completion date June 20, 2019
Est. primary completion date June 20, 2019
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria:

- Patients with NYHA Class II or III or ambulatory IV HF symptoms

- Optimal HF Medical Therapy of at least 3 months (2009 ACCF/AHA, ESC 2012)

- LVEF less than or equal to 35%

- Sinus rhythm (can have paroxysmal atrial fibrillation)

- QRS morphology is non-RBBB

- QRS durations more than or equal to 120 ms, but less than 150 ms

- Patients are able to receive chronic oral anticoagulation

- Patients with pacemaker or ICD that meet the above criteria may be upgraded to CRT-D or CRT-P

Exclusion Criteria:

- Planned Atrial Fibrillation Ablation within 12 months

- Patients with mitral or tricuspid prosthetic valve that precludes the placement of an LV lead transvenously or trans-septally

- Patients with RBBB

- Patients with LV thrombus

- Patients with permanent atrial fibrillation

- Patients with contraindications to oral anti-coagulation

- In-hospital patients with acute cardiac or non-cardiac illness that requires intensive care

- Acute coronary syndrome (including MI) < 4 weeks

- Coronary revascularization (CABG or PCI) < 3 months

- Uncorrected or uncorrectable primary valvular disease

- Restrictive, hypertrophic or reversible form of cardiomyopathy

- Severe primary pulmonary disease such as cor pulmonale

- Expected to undergo cardiac transplantation within one year (status I)

- Patients with a life expectancy of less than one year from non-cardiac cause.

- Patients included in other clinical trials that will affect the objectives of this study

- Those unable or unwilling to provide informed consent

- Those with a history of noncompliance to medical therapy

Study Design


Related Conditions & MeSH terms


Intervention

Device:
Conventional CRT
Patients randomized to the Conventional CRT will receive a CRT device with or without ICD. Device implantation will be performed within 10 working days of randomization. Conscious sedation or general anesthesia can be used for the implant procedure. The device will be implanted in a facility that has the capacity to perform coronary sinus venography at the time of implantation. The RA lead will be placed in the RA appendage or high RA. The RV lead should be placed at the RV apex or distal RV septum (R wave > 7 mV, pacing threshold < 1.5 V at a pulse-width of 0.5 ms). The LV lead should be positioned through the CS to an LV branch. The lead should be placed at one of the left ventricular venous branches, avoiding the LV apex and scar region identified by pre-implant imaging.
LV endocardial CRT
Patients randomized to LV endocardial CRT will receive a CRT device with or without ICD, placed in the same time frame, and will have RA and RV leads implanted as the conventional CRT group. The device will be implanted in a facility that has the capacity to perform trans-atrial septal puncture with ultrasound guidance (TEE or ICE) at the time of implantation. The LV lead will be placed using a trans-atrial septal approach, using a specially designed puncture tools and LVendo delivery tool kits specifically designed for this study. Special care will be taken to avoid the LV apex and transmural scar identified by pre-implant imaging.

Locations

Country Name City State
Canada Libin Cardiovascular Institute Calgary Alberta
Canada Queen Elizabeth II Health Science Halifax Nova Scotia
Canada London Health Science Centre London Ontario
Canada McGill University Health Centre Montréal Quebec
Canada Montreal Heart Institute Montréal Quebec
Canada Royal Columbia Hospital New Westminster British Columbia
Canada University of Ottawa Heart Institute Ottawa Ontario
Canada Institut Univ.cardiologie/pneumologie de Québec Quebec City Quebec
Canada CHUS Le Centre hospitalier universitaire de Sherbrooke Sherbrooke Quebec
Canada St. Michael Hospital Toronto Ontario
Canada Vancouver General Hospital Vancouver British Columbia

Sponsors (2)

Lead Sponsor Collaborator
Lawson Health Research Institute Medtronic

Country where clinical trial is conducted

Canada, 

Outcome

Type Measure Description Time frame Safety issue
Other Thromboembolic Events Investigator deemed to be directly related to the therapy Safety Baseline to 12 months
Other Safety: LVendo CRT: specific system placement procedure related adverse events Safety Baseline to 12 months
Other Safety:Pocket infection requiring extending hospitalization > 24 hours or requiring surgical intervention Baseline to 12 months
Other Safety:Lead(s) dislodgement requiring repositioning or cessation of CRT Baseline to 12 months
Other Safety:Cardiac tamponade requiring intervention Baseline to 12 months
Other Safety:Phrenic nerve stimulation Baseline to 12 months
Primary Assessment of LVESVi LV reverse remodeling as measured by the difference of LVESVi on echocardiography (echo) Baseline to 6 months & 12 months
Secondary Ventricular arrhythmia burden determined by the device capture of arrhythmias and adjudication by a device review committee blinded to patient's treatment allocation. Baseline to 6 months & 12 months
Secondary NT-proBNP measurement Baseline to 6 months & 12 months
Secondary 6 Minute Hall Walk Distance Baseline to 6 months & 12 months
Secondary Quality of Life Measure EQ5D-5L & Minnesota Living with HF Baseline to 6 months & 12 months
Secondary Mortality Baseline to 6 months & 12 months
Secondary Heart Failure Admissions Baseline to 6 months & 12 months
Secondary Reduction of LVEF Baseline to 6 months & 12 months