Early Elimination of Premature Ventricular Contractions in Heart Failure

Not Applicable

Terminated

Conditions: Premature Ventricular Contractions
Congestive Heart Failure

Interventions: Device: PVC ablation

Registration Number: NCT01757067

Lead Sponsor: University of Maryland, Baltimore

Brief Summary: Premature ventricular contractions (PVC) are a very common irregular heart beat (arrhythmias) even in patients without heart disease. Frequent PVCs are thought to occur in about 1-4% of the general population. Many patients with PVCs complain about skipping of their heart (palpitations), shortness of breath and feeling tired. In some patients PVCs may also result in weakening of the heart muscle (heart failure), which might be reversible with suppression of the PVCs.

Detailed Description: A common way to get rid of PVCs is an ablation procedure during which a small area of heart muscle that creates the PVCs is cauterized, so that it can no longer cause PVCs. This has been performed for many years and is an overall safe and effective procedure to eliminate PVCs. In the ablation, a catheter with an electrode at its tip is guided with moving X-rays (fluoroscopy) displayed on a video screen to the exact site inside the heart where cells give off the electrical signals that stimulate the abnormal heart rhythm. Radiofrequency energy (similar to microwave heat) is transmitted from the catheter tip to the area. This destroys carefully selected heart muscle cells in a very small area (about 1/5 of an inch) and can stop the area from creating the extra impulses that cause the extra heartbeats. Additionally, some medications have the ability to suppress PVCs (antiarrhythmic medications). PVC ablation and antiarrhythmic medications have both been used to treat patients with PVC's and a reduced heart function. The heart function is referred to as ejection fraction (measured by cardiac ultrasound (echocardiogram). In this study it will be required the ejection fraction will be less than less than or equal to 45% (with 55% or more being normal).

If enrolled in the study there is a 50/50 chance (like a coin toss and referred to as randomization) that the patient will either continue on the best currently available medical treatment for a weak heart muscle (as determined by the doctor) or will undergo a PVC catheter ablation (with a possible second ablation or antiarrhythmic medication, if the first ablation was not a success).

All patients in the study will continue to take the best possible medications for the heart muscle weakness. If the patient is randomized to not undergo the ablation they will be monitored and at the end of 6 months of participation may choose to have the PVC ablation. If a deterioration may occur patients in the control group can have an ablation earlier.

Recruitment & Eligibility

Status: TERMINATED

Sex: All

Target Recruitment: 3

Inclusion Criteria

Patients with reduced ejection fraction (EF ≤45%) demonstrated by transthoracic echocardiogram and deemed to be non-ischemic by nuclear stress test or cardiac catheterization.
Patients with >20% PVCs on 24 hour holter-recording
Patient is 18 years of age or older
Optimized medical therapy on stable therapy for minimum 3 months with no changes in beta-blocker, ACE-I/ARB, digoxin doses (varying diuretic doses permitted).

Exclusion Criteria

Patients who are under the age of 18 years of age
Patients with >2 dominant PVC morphologies
Patients with cardiac surgery in previous 3 months or scheduled for following 6 months
Patients who were implanted with a biventricular device during the last three months or single/dual chamber device (with ventricular pacing >10%) during the last three months
Significant symptoms associated with PVCs that would make favor immediate ablation
Intracardiac mural thrombus or myxoma
Pregnancy

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
ablation procedure vs medical therapy	PVC ablation	PVC ablation vs medical therapy

Primary Outcome Measures

Name	Time	Method
Change of Left Ventricular Ejection Fraction Measured With Simpson's Rule Expressed in Percent From Pre to Post Intervention	Change between 0 and 6 months	Left ventricular ejection fraction with Simpson's Rule. This is a measurement obtained on an echocardiogram. It reflects the percentage of blood that is ejected from the heart with each beat. The mean change in ejection fraction will be compared for the 2 groups

Secondary Outcome Measures

Name	Time	Method

Trial Locations

Locations (8): University of Quebec
🇨🇦
Sainte-Foy, Quebec, Canada
UCLA
🇺🇸
Los Angeles, California, United States
University of Maryland Medical Center
🇺🇸
Baltimore, Maryland, United States
University of Pennsylvania
🇺🇸
Philadelphia, Pennsylvania, United States
University maryland medical Center
🇺🇸
Baltimore, Maryland, United States
Brigham and Women's Hospital
🇺🇸
Boston, Massachusetts, United States
University of Michigan
🇺🇸
Ann Arbor, Michigan, United States
Ohio State University
🇺🇸
Columbus, Ohio, United States