MINERVA: MINimizE Right Ventricular Pacing to Prevent Atrial Fibrillation and Heart Failure

NCT ID: NCT00262119

Last Updated: 2025-07-02

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

1300 participants

Study Classification

INTERVENTIONAL

Study Start Date

2006-02-28

Study Completion Date

2013-04-30

Brief Summary

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The aim of this study is to test the impact of the managed ventricular pacing (MVP) mode and atrial preventive and antitachycardia pacing therapies on the reduction of a composite clinical outcome composed of any death, permanent atrial fibrillation, and cardiovascular hospitalizations.

Detailed Description

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Kristensen et al. reported that AAIR pacing reduces atrial fibrillation (AF) development compared to DDDR pacing in sinus node disfunction patients.

Several authors have shown that, in patients with intact AV conduction, unnecessary chronic RV pacing can cause detrimental effects such as AF, left ventricular (LV) dysfunction and congestive heart failure. These findings arose the hypothesis that the non-physiologic nature of ventricular pacing may result in electrophysiological and LV remodeling changes that have potentially deleterious long-term effects.

The MVP mode, present in the Medtronic pacemaker EnRhythm, provides atrial based pacing with ventricular backup. It operates in true AAI(R) mode, it provides ventricular backup in case of a single conduction loss and converts to DDD(R) mode in case of persistent loss of AV conduction.

Aim of this study is to test the impact of the MVP pacing mode and atrial preventive and antitachycardia pacing therapies on the reduction of a composite clinical outcome composed by any death, permanent AF, cardiovascular hospitalizations.

Conditions

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Atrial Fibrillation Heart Failure, Congestive

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Participants

Study Groups

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Control Group

PM programming according to actual clinical practice

Group Type ACTIVE_COMPARATOR

Pacemaker Medtronic EnRhythm

Intervention Type DEVICE

Pacemaker specific programming

MVP Only

PM programming according to actual clinical practice + MVP algorithm ON

Group Type ACTIVE_COMPARATOR

Pacemaker Medtronic EnRhythm

Intervention Type DEVICE

Pacemaker specific programming

DDDRP

PM programming according to actual clinical practice + MVP algorithm ON + Atrial fibrillation therapies ON

Group Type ACTIVE_COMPARATOR

Pacemaker Medtronic EnRhythm

Intervention Type DEVICE

Pacemaker specific programming

Interventions

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Pacemaker Medtronic EnRhythm

Pacemaker specific programming

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Class I/Class II indications for dual chamber pacing
* Previous implant of an EnRhythm dual chamber implantable pulse generator (IPG) since maximum 2 weeks
* History of atrial arrhythmias (at least one electrocardiogram \[ECG\] or Holter documented episodes in the last 12 months)

Exclusion Criteria

* Less than 18 years of age
* Pregnancy
* Unwilling or unable to give informed consent or to commit to follow-up schedule
* Medical conditions that preclude protocol required testing or limit study participation
* Enrolled or intend to participate in another clinical trial during the course of this study
* A life expectancy of less than 2 years
* Patient is a candidate for an implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy (CRT) device implant
* Anticipated major cardiac surgery within the course of this study
* Permanent III degree AV-block or history of AV node ablation
* History of permanent AF (as defined below)
* AF ablation (left pulmonary veins) or other cardiac surgery \< 3 months
* Prior implant of defibrillator device or pacemaker (apart from EnRhythm IPG implanted within two weeks)
* Uncontrolled hyperthyroidism
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Medtronic Cardiac Rhythm and Heart Failure

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Luigi Padeletti, Prof.

Role: PRINCIPAL_INVESTIGATOR

Ospedale Careggi - Firenze

Giuseppe Boriani, Dr.

Role: PRINCIPAL_INVESTIGATOR

Ospedale Sant'Orsola - Bologna

Luis Mont, Dr.

Role: PRINCIPAL_INVESTIGATOR

Hospital Clinic of Barcelona

Reinhard C Funck, Dr.

Role: PRINCIPAL_INVESTIGATOR

Philipps University Hospital - Marburg

Carsten W Israel, Dr.

Role: PRINCIPAL_INVESTIGATOR

J. W. Goethe University Hospital - Frankfurt

Helmut Pürerfellner, Dr.

Role: PRINCIPAL_INVESTIGATOR

Elisabethinen Hospital

Antonis S Manolis, Prof.

Role: PRINCIPAL_INVESTIGATOR

Evagelismos Hospital - Athens

André Pisapia, Dr

Role: PRINCIPAL_INVESTIGATOR

Hôpital Saint-Joseph - Marseille

Raymond Tukkie, Dr

Role: PRINCIPAL_INVESTIGATOR

Kennemer Gasthuis

Locations

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Medtronic Italia S.p.A.

Rome, , Italy

Site Status

Countries

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Italy

References

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Connolly SJ, Kerr CR, Gent M, Roberts RS, Yusuf S, Gillis AM, Sami MH, Talajic M, Tang AS, Klein GJ, Lau C, Newman DM. Effects of physiologic pacing versus ventricular pacing on the risk of stroke and death due to cardiovascular causes. Canadian Trial of Physiologic Pacing Investigators. N Engl J Med. 2000 May 11;342(19):1385-91. doi: 10.1056/NEJM200005113421902.

Reference Type BACKGROUND
PMID: 10805823 (View on PubMed)

Lamas GA, Lee KL, Sweeney MO, Silverman R, Leon A, Yee R, Marinchak RA, Flaker G, Schron E, Orav EJ, Hellkamp AS, Greer S, McAnulty J, Ellenbogen K, Ehlert F, Freedman RA, Estes NA 3rd, Greenspon A, Goldman L; Mode Selection Trial in Sinus-Node Dysfunction. Ventricular pacing or dual-chamber pacing for sinus-node dysfunction. N Engl J Med. 2002 Jun 13;346(24):1854-62. doi: 10.1056/NEJMoa013040.

Reference Type BACKGROUND
PMID: 12063369 (View on PubMed)

Mattioli AV, Vivoli D, Mattioli G. Influence of pacing modalities on the incidence of atrial fibrillation in patients without prior atrial fibrillation. A prospective study. Eur Heart J. 1998 Feb;19(2):282-6. doi: 10.1053/euhj.1997.0616.

Reference Type BACKGROUND
PMID: 9519322 (View on PubMed)

Andersen HR, Nielsen JC, Thomsen PE, Thuesen L, Mortensen PT, Vesterlund T, Pedersen AK. Long-term follow-up of patients from a randomised trial of atrial versus ventricular pacing for sick-sinus syndrome. Lancet. 1997 Oct 25;350(9086):1210-6. doi: 10.1016/S0140-6736(97)03425-9.

Reference Type BACKGROUND
PMID: 9652562 (View on PubMed)

Kristensen L, Nielsen JC, Mortensen PT, Pedersen OL, Pedersen AK, Andersen HR. Incidence of atrial fibrillation and thromboembolism in a randomised trial of atrial versus dual chamber pacing in 177 patients with sick sinus syndrome. Heart. 2004 Jun;90(6):661-6. doi: 10.1136/hrt.2003.016063.

Reference Type BACKGROUND
PMID: 15145874 (View on PubMed)

Nielsen JC, Andersen HR, Thomsen PE, Thuesen L, Mortensen PT, Vesterlund T, Pedersen AK. Heart failure and echocardiographic changes during long-term follow-up of patients with sick sinus syndrome randomized to single-chamber atrial or ventricular pacing. Circulation. 1998 Mar 17;97(10):987-95. doi: 10.1161/01.cir.97.10.987.

Reference Type BACKGROUND
PMID: 9529267 (View on PubMed)

Nielsen JC, Kristensen L, Andersen HR, Mortensen PT, Pedersen OL, Pedersen AK. A randomized comparison of atrial and dual-chamber pacing in 177 consecutive patients with sick sinus syndrome: echocardiographic and clinical outcome. J Am Coll Cardiol. 2003 Aug 20;42(4):614-23. doi: 10.1016/s0735-1097(03)00757-5.

Reference Type BACKGROUND
PMID: 12932590 (View on PubMed)

Boriani G, Tukkie R, Manolis AS, Mont L, Purerfellner H, Santini M, Inama G, Serra P, de Sousa J, Botto GL, Mangoni L, Grammatico A, Padeletti L; MINERVA Investigators. Atrial antitachycardia pacing and managed ventricular pacing in bradycardia patients with paroxysmal or persistent atrial tachyarrhythmias: the MINERVA randomized multicentre international trial. Eur Heart J. 2014 Sep 14;35(35):2352-62. doi: 10.1093/eurheartj/ehu165. Epub 2014 Apr 25.

Reference Type DERIVED
PMID: 24771721 (View on PubMed)

Funck RC, Boriani G, Manolis AS, Puererfellner H, Mont L, Tukkie R, Pisapia A, Israel CW, Grovale N, Grammatico A, Padeletti L; MINERVA Study Group. The MINERVA study design and rationale: a controlled randomized trial to assess the clinical benefit of minimizing ventricular pacing in pacemaker patients with atrial tachyarrhythmias. Am Heart J. 2008 Sep;156(3):445-51. doi: 10.1016/j.ahj.2008.05.004.

Reference Type DERIVED
PMID: 18760124 (View on PubMed)

Other Identifiers

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MNV-20-171005

Identifier Type: -

Identifier Source: org_study_id

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