Ventricular Fibrillation Clinical Trial
Official title:
The Leiden Nonischemic Cardiomyopathy Study
Verified date | February 2020 |
Source | Leiden University Medical Center |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Observational |
Rationale: Sudden cardiac death, mainly caused by ventricular arrhythmias (VA), is a major
cause of morbidity and mortality in non-ischemic cardiomyopathy (NICM). Therapies that
effectively prevent VA are lacking. Improved understanding of the substrate and mechanisms of
VA in NICM may allow more effective, individualized and substrate-based therapies to be
developed. In addition, risk stratification in NICM needs to be improved so that therapies
can be allocated more efficiently.
Objectives: 1) To improve our understanding of the underlying pro-arrhythmic substrate and
electrophysiologic mechanisms of VA in NICM, and to develop individualized treatment for VA
based on the identified substrate. 2) To improve risk stratification for VA and sudden
cardiac death in NICM based on substrate characteristics. 3) to evaluate disease progression
in NICM.
Hypothesis: Improved understanding of the substrate and mechanisms of VA in NICM may allow
more effective, individualized and substrate-based therapies to be developed.
Study design: A prospective cohort study.
Study population: The study population will consist of three groups (A, B and C): NICM
patients with documented VA, suspected VA or intermediate to high risk for VA (according to
established criteria) who are not referred for cardiac surgery (group A), NICM patients with
documented VA, suspected VA or a high risk for VA who are referred for cardiac surgery (group
B) and a control group consisting of patients without NICM who are referred for cardiac
surgery (group C).
Evaluation: All patients will be evaluated according to current standards for patients with
NICM. Evaluation will include 24h-Holter, echocardiography, coronary angiogram and
contrast-enhanced MRI (CE-MRI). If CE-MRI is performed in another hospital, additional
recordings will be performed in our hospital. Additionally, blood samples (arterial, cardiac
venous and peripheral venous) for collagen turnover markers will be taken from all patients.
123-iodine metaiodobenzylguanidine (123-I MIBG) imaging, electrophysiologic study and
endomyocardial biopsy will be performed in group A and B. Intra-operative biopsy will be
performed in group B and C.
Intervention: In group B, intra-operative mapping and cryo-ablation and postoperative
electrophysiologic study will be performed in patients with subepicardial late enhancement on
MRI or induced VA suspected for an subepicardial origin.
Main study parameters/endpoints: The main study parameters are extent, location and pattern
of fibrosis on imaging and in biopsy specimens. The main study endpoints are inducibility of
VA, type of induced VA, spontaneous VA and type of spontaneous VA.
Status | Completed |
Enrollment | 148 |
Est. completion date | September 2019 |
Est. primary completion date | September 2019 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years to 80 Years |
Eligibility |
Inclusion criteria, group A: - Nonischemic cardiomyopathy - Documented ventricular arrhythmia, suspected ventricular arrhythmia (e.g. because of out-of-hospital cardiac arrest, palpitations or syncope) or high risk for ventricular arrhythmias (LVEF = 35%) or intermediate risk for ventricular arrhythmias (LVEF = 50% and late enhancement on contrast-enhanced MRI) - Admission not for cardiac surgery Inclusion criteria, group B: - Nonischemic cardiomyopathy - Documented ventricular arrhythmia or suspected ventricular arrhythmia (e.g. because of out-of-hospital cardiac arrest, palpitations or syncope) or high risk for ventricular arrhythmia (LVEF = 35%) - Admission for cardiac surgery (e.g., mitral valve annuloplasty or CorCap) Inclusion criteria, group C: - Patients undergoing aortic valve replacement or coronary artery bypass graft surgery Exclusion criteria, all groups: - Age < 18 years or > 80 years - Inadequate patient competence - Pregnancy - Inability to comply with the protocol due to haemodynamic instability Exclusion Criteria, groups A and B: - Other cardiomyopathy (e.g., prior myocardial infarction, infiltrative cardiac disease such as sarcoidosis, amyloidosis or Chagas cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy/dysplasia, hypertrophic cardiomyopathy, non-compaction cardiomyopathy and congenital heart disease) Exclusion criteria, group C: - Nonischemic cardiomyopathy - Prior myocardial infarction |
Country | Name | City | State |
---|---|---|---|
Netherlands | Dept. of Cardiology, Leiden University Medical Center | Leiden |
Lead Sponsor | Collaborator |
---|---|
Leiden University Medical Center |
Netherlands,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Inducibility of ventricular arrhythmias | Baseline electrophysiological study | ||
Primary | Type of induced ventricular arrhythmias | Baseline electrophysiological study | ||
Primary | Spontaneous ventricular arrhythmias | Up to 10 years | ||
Primary | Type of spontaneous ventricular arrhythmias | Up to 10 years | ||
Secondary | Hospital admissions for heart failure | Up to 10 years | ||
Secondary | Cardiac mortality | Up to 10 years | ||
Secondary | All-cause mortality | Up to 10 years | ||
Secondary | LV function/dimensions/compact fibrosis deterioration as assessed by 123-I MIBG imaging and/or CE-MRI | 18 months |
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