PAUSE-SCD: Pan-Asia United States PrEvention of Sudden Cardiac Death Catheter Ablation Trial
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 180
- 试验地点
- 13
- 主要终点
- Freedom From Recurrent VT, Cardiovascular Rehospitalization, and All-cause Mortality
研究概览
简要总结
The current standard of care for ventricular tachycardia (VT) includes the use of medicine called anti-arrhythmic drugs (AADs) and Implantable Cardioverter Defibrillator (ICD) therapy. These treatments are used to terminate the irregular heartbeats and bring the heart back to a normal rhythm. Catheter ablation is a procedure used to eliminate (damage) the heart cells causing the arrhythmia. Patients eligible for this may benefit from an ablation procedure in addition to an ICD to treat their VT condition or risk of developing VT. This study aims to show that treating VT with catheter ablation, if performed preemptively at the time of ICD implantation, will reduce subsequent recurrent VT, ICD shocks, and lead to improved survival.
详细描述
Subjects who meet inclusion/exclusion criteria will be entered into the randomized trial. Randomization will be 1:1 between control group and ablation group. Those randomized to the control group will receive ICD therapy and routine drug therapy (including antiarrhythmic drugs as indicated). Subjects randomized to the ablation group will receive ablation therapy plus ICD for ventricular tachycardia. Patients that refuse ICD therapy and undergo ablation only will be enrolled in a prospective registry.
Follow-up will be performed prior to hospital discharge for incision check and device interrogation as is standard of care. In addition, routine device and clinical follow-up will be scheduled at 1, 3, 6, 12, 18, and 24 months. Electrocardiography (ECG) will be performed pre-implant and prior to hospital discharge. Echocardiography (TTE) will be performed pre-implant and at 12 and 24 months.
Patients that refuse ICD implantation will not be randomized and will be approached for inclusion into a registry if they undergo catheter ablation without an ICD. Basic demographics and medical history will be collected from registry subjects upon enrollment. Registry subjects will receive follow-up for routine clinical care every 6 months to check on their overall status.
120 subjects will be randomized. An additional 60 subjects will enrolled into the registry.
As of the time protocol revision C changes were made (07Nov2016), 33 subjects have been randomized. There has not been any preliminary or interim analysis of any data at this point. The study-sponsor has not had any access to any clinical follow-up for the patients enrolled to date.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patient is receiving a new implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy device (CRT-D) implant that has study required programing capabilities and is appropriate for remote monitoring. Patient who has received the ICD / CRT-D within 90 days of enrollment can also be enrolled.
- •Patient who has a high risk of ICD shock as shown by documented Monomorphic VT (MMVT) by one or more of the following:
- •Spontaneous MMVT
- •Inducible MMVT during electrophysiology study,
- •Inducible MMVT during noninvasive programmed stimulation study *Inducible MMVT is defined as MMVT > 30 seconds or requiring electrical termination (ATP or cardioversion)
- •Patient has ejection fraction < 50% or right ventricular dysfunction
- •Patient has a cardiomyopathy with structural heart disease of any cause
排除标准
- •Any history of debilitating stroke with neurologic deficit
- •ST-segment elevation myocardial infarction or previous cardiac surgery within 60 days prior to enrollment
- •Patient is pregnant or nursing
- •Patient has chronic New York Heart Association (NYHA) class IV heart failure
- •Patient has incessant VT necessitating immediate treatment
- •Patient has ventricular tachycardia/ventricular fibrillation thought to be from channelopathies
- •Limited life expectancy (less than one year)
- •Patient has current class IV angina
- •Recent coronary artery bypass graft or percutaneous coronary intervention (< 45 days)
- •Patient is currently participating in another investigational drug or device study
- •Known presence of intracardiac thrombi
- •Prosthetic mitral or aortic valve or mitral or aortic valvular heart disease requiring immediate surgical intervention
- •Major contraindication to anticoagulation therapy or coagulation disorder
- •Left Ventricular Ejection Fraction < 15%
- •Patient has had a previous ablation procedure for VT, excluding remote (> 3 months) outflow tract tachycardia
- •Patient has glomerular filtration rate (GFR) < 30 mL/min/1.73m2
- •Patient has peripheral vascular disease that precludes left ventricular access
- •Patient is thought to have idiopathic outflow VT as only VT
- •Patient has a premature ventricular contraction (PVC) or VT induced cardiomyopathy that is expected to resolve with ablation and will not require an ICD
- •Patient has reversible cause of VT
- •Patient does not meet criteria for ICD or CRT-D
研究组 & 干预措施
ICD with Ablation
Patient will receive an implantable cardioverter defibrillator (ICD) with catheter ablation and standard medical management.
干预措施: Implantable Cardioverter Defibrillator (ICD) (Device)
ICD with Ablation
Patient will receive an implantable cardioverter defibrillator (ICD) with catheter ablation and standard medical management.
干预措施: Catheter Ablation (Procedure)
ICD Only
Patient will receive an implantable cardioverter defibrillator (ICD) and standard medical management.
干预措施: Implantable Cardioverter Defibrillator (ICD) (Device)
Ablation Only (Registry)
The registry will enroll patients who refuse an implantable cardioverter defibrillator (ICD) and are thus not randomized. This arm will assess the efficacy of catheter ablation in the absence of background ICD therapy.
干预措施: Catheter Ablation (Procedure)
结局指标
主要结局
Freedom From Recurrent VT, Cardiovascular Rehospitalization, and All-cause Mortality
时间窗: 2 years
The primary endpoint is a composite.
次要结局
- Freedom From Recurrent VT(2 years)
- Freedom From Cardiovascular Rehospitalization(2 years)
- Freedom From All-cause Mortality(2 years)