Adaptive Cardiac Resynchronization Therapy Study
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Heart Failure
- Sponsor
- Medtronic Cardiac Rhythm and Heart Failure
- Enrollment
- 522
- Primary Endpoint
- Percentage of Patients With a Safety Event (Inappropriate AV or VV Delay Settings Related to the aCRT Feature)
- Status
- Completed
- Last Updated
- 7 years ago
Overview
Brief Summary
The purpose of this study is to demonstrate the AdaptivCRT algorithm is at least as good as manual echo based optimization in regard to patient outcomes and cardiac performance
Detailed Description
The trial has 3 primary end points: * to demonstrate that over 6-month follow-up, the proportion of the patients improved in the aCRT arm is at least as high as in the Echo arm * to demonstrate that cardiac function is similar when using aCRT versus echo-optimized settings * to demonstrate that aCRT does not result in inappropriate AV or VV delay settings
Investigators
Eligibility Criteria
Inclusion Criteria
- •Subject is willing to sign and date the study Informed Consent form
- •Subject is at least 18 years of age (or older, if required by local law)
- •Subject is expected to remain available for at least six months of follow-up visits
- •Subject is indicated for a study device that will be implanted within 30 days after signing the Informed Consent form
- •Subject has an intrinsic QRS duration greater than or equal to 120 milliseconds (documented within 30 days prior to enrollment)
- •Subject has a left ventricular ejection fraction less than or equal to 35 percent (method per physician discretion) (documented within 180 days prior to enrollment)
- •Subject is diagnosed with New York Heart Association (NYHA) class III or IV (within 30 days prior to enrollment) despite optimal medical therapy which is defined as: ACE-inhibitor (Angiotensin-Converting Enzyme) or Angiotensin II Receptor Blocker (ARB), if tolerated, for at least one month prior to implant, AND beta-blocker for at least three months preceding implant, if tolerated, and stable for one month, OR subject has an urgent medical need for an implantable cardioverter defibrillator (ICD) that precludes waiting the one or three months for the medication requirements for ACE inhibitor, ARB or beta-blocker
Exclusion Criteria
- •Subject has chronic (permanent) atrial arrhythmias for which pharmacological therapy and/or cardioversion have been unsuccessful or have not been attempted
- •Subject has existing CRT system
- •Subject has non-intact or unstable leads
- •Subject has medical conditions that would limit study participation (per physician discretion)
- •Subject is enrolled in one or more concurrent studies that would confound the study results of this study as determined by Medtronic
- •Subject has unstable angina, or experienced an acute myocardial infarction (MI) or received coronary artery revascularization (CABG) or coronary angioplasty (PTCA) (documented within 30 days prior to enrollment)
- •Subject has a mechanical right heart valve or is scheduled to undergo valve repair or valve replacement during the course of the study
- •Subject is post-heart transplant (subjects on the heart transplant list for the first time are not excluded)
- •Subject has a limited life expectancy that would not allow completion of the 6 month visit
- •Subject is pregnant (In the United States, all women of child-bearing potential must undergo a pregnancy test within seven days prior to aCRT download into device)
Outcomes
Primary Outcomes
Percentage of Patients With a Safety Event (Inappropriate AV or VV Delay Settings Related to the aCRT Feature)
Time Frame: randomization to 6 months post randomization
For each subject, the Adaptive CRT-determined AV and VV delay settings from randomization up to 183-days post-randomization were evaluated to identify any period of 28-days with a wide delay range (\>60 ms)
Percentage of Patients With Improved Heart Failure Outcomes Clinical Composite Score
Time Frame: randomization to six month visit
Patients considered worsened if they died, were hospitalized with worsening heart failure (HF), crossed over to other arm, demonstrated worsening in New York Heart Association (NYHA) functional class, or reported moderately/markedly worse on 'patient global assessment' compared to before CRT implant. Patients are improved if they are not worsened and have an improved NYHA or reported moderately/markedly improved on the 'patient global assessment' compared to before CRT implant Global assessment question for the patient: Specifically in reference to your heart failure symptoms, how do you feel today as compared to how you felt before your CRT system was implanted? O Markedly improved O Moderately improved O Mildly improved O No change O Slightly worse O Moderately worse O Markedly worse
Correlation Between Aortic Velocity Time Integral (AoVTI) at Adaptive CRT and Echo-optimized Device Settings
Time Frame: randomization visit and six month visit
Correlation between aortic velocity time integral (AoVTI) at Adaptive CRT and echo-optimized device settings. AoVTI is an echocardiographic representative of stroke volume and cardiac performance.
Secondary Outcomes
- Change in Left Ventricular End Systolic Volume Index (LVESVi)(baseline to six month visit)
- Change in Quality of Life Measured by the Minnesota Living With Heart Failure Questionnaire (MLWHF)(baseline to six month visit)
- Change in Left Ventricular Ejection Fraction (LVEF)(baseline to six month visit)
- Right Ventricular Pacing Percentage(implant to six months post randomization)
- Change in Distance Walked During the Six Minute Hall Walk(baseline to six month visit)
- Change in New York Heart Association (NYHA) Classification(baseline to six month visit)