Effects of Atrial Rate-adaptive Pacing on Exercise Capacity in Patients With Chronic Heart Failure Complicated by Chronotropic Incompetence

NCT ID: NCT01016431

Last Updated: 2011-06-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

20 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-11-30

Study Completion Date

2012-08-31

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

Chronotropic incompetence consists of an insufficient increase in heart rate during effort, and its presence is recognized as a common feature in patients with heart failure due to left ventricular systolic dysfunction, apparently suggesting a worse prognosis. Little is known about the possible benefits of its reversal in such patients.

The investigators working hypothesis is that the modulation of chronotropic response, as obtained by means of atrial rate-adaptive pacing may improve functional capacity in persons with chronic heart failure and chronotropic incompetence.

To explore this hypothesis,the investigators will enroll 20 patients with NYHA II/III heart failure, low left ventricular ejection fraction (\<40%) and chronotropic incompetence (Maximal heart rate \<80% of predicted value in a symptom-limited incremental test), who already underwent implantation of dual-chamber implantable defibrillator for prevention of sudden cardiac death. The study will have a randomized, double-blind, cross-over design.

The procedures, to be carried out at one month from each reprogramming (VVI backup pacing vs. AAI-R "active" pacing), will comprise: blood sampling for NT-proBNP, incremental symptom-limited cardiopulmonary exercise testing (CPX), constant-workload cardiopulmonary test (50% of max WR), quality-of-life questionnaire, 24-hour ECG monitoring.

The primary end-point will be peak oxygen consumption on CPX. Secondary end-points will include acute response to reprogramming, and data derived from constant-WR tests, Holter monitoring and QoL.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Heart Failure Exercise Tolerance

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

Rate adaptive

Patients will have their ICD programmed in a AAI-R mode, with peak atrial rate set at 85% of age-adjusted predicted maximal HR

Group Type EXPERIMENTAL

Rate-adaptive pacemaker programming

Intervention Type OTHER

The ICD will be programmed in a AAI-R mode, with peak atrial stimulation rate set at 85% of maximal predicted heart rate, and ongoing protection VVI backup at 40 bpm

Control

ICDs will be programmed in the usual VVI backup pacing mode at 40 bpm

Group Type ACTIVE_COMPARATOR

VVI at 40 bpm

Intervention Type OTHER

ICDs will be programmed in VVI mode at 40 bpm

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

Rate-adaptive pacemaker programming

The ICD will be programmed in a AAI-R mode, with peak atrial stimulation rate set at 85% of maximal predicted heart rate, and ongoing protection VVI backup at 40 bpm

Intervention Type OTHER

VVI at 40 bpm

ICDs will be programmed in VVI mode at 40 bpm

Intervention Type OTHER

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* NYHA II/III chronic heart failure on optimal medical therapy
* Sinus Rhythm
* Left ventricular ejection fraction less than 40 %
* Chronotropic incompetence on maximal exercise testing (maximum heart rate \< 80% of predicted value)
* Age 18-75
* carrier of dual chamber ICD device
* Informed Consent

Exclusion Criteria

* Unable to perform cardiopulmonary exercise testing (for any reason)
* Absolute contraindication to maximal exercise testing
* Moderate to severe anemia (Hb\<10 g/dL)
* Diagnosis of Sick Sinus Syndrome or high-degree atrioventricular block
* recent hospitalization for acute decompensated heart failure (\<1 month)
* recent acute coronary syndrome (\<3 months)
* Active neoplastic disease
* Active myocarditis / endocarditis
* Acute decompensated heart failure during study
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

Federico II University

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Federico II University

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

Federico II University - Department of Internal Medicine

Naples, , Italy

Site Status RECRUITING

Countries

Review the countries where the study has at least one active or historical site.

Italy

Central Contacts

Reach out to these primary contacts for questions about participation or study logistics.

Serafino Fazio, MD

Role: CONTACT

+390817463737

Guido Carlomagno, MD

Role: CONTACT

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

CHRON-INC-09

Identifier Type: -

Identifier Source: org_study_id

More Related Trials

Additional clinical trials that may be relevant based on similarity analysis.

Short Atrioventricular Delay Pacing
NCT01233661 WITHDRAWN NA
Risk Factors in Tachycardiomyopathy
NCT03418467 ACTIVE_NOT_RECRUITING