Combining Myocardial Strain and Cardiac CT to Optimize Left Ventricular Lead Placement in CRT Treatment

NCT ID: NCT01426321

Last Updated: 2019-03-28

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

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-08-31

Study Completion Date

2018-12-31

Brief Summary

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For patients with advanced heart failure, Cardiac Resynchronization Therapy (CRT) has been a major improvement. The treatment improves symptoms and prolongs life in selected patients with heart failure. However, with the current selection criteria and methods for implanting the pacemaker, only 60-70% of the patients derive significant benefit from the treatment.

New imaging techniques, including advanced ultrasound and computed tomography, in combination with new versatile multi-pole electrodes, have made an individually tailored therapy possible. Using these techniques in combination, the study will investigate the effect of individually based "optimal" placement of the pacemaker electrodes vs. standard care. The optimal LV electrode position is defined as pacing a viable segment with the latest mechanical delay, targeting a specific segment of the coronary sinus as visualised on cardiac CT. The hypothesis is that this will increase the number of positive responders from 65% to 85%.

Detailed Description

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Conditions

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Heart Failure

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Imaging guided LV lead positioning

Group Type ACTIVE_COMPARATOR

Imaging guided LV lead positioning

Intervention Type OTHER

LV lead positioning guided by echocardiography (mechanical strain evaluation by speckle tracking) in combination with cardiac CT. A viable segment with the latest mechanical activation is targeted, and an appropriate "optimal" cardiac vein segment is then chosen using the CT images.

Standard LV lead positioning

The LV lead position is decided at the discretion of the treating physician. Cardiac CT images are available for viewing, but no echocardiography data regarding segmental myocardial strain are available.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Imaging guided LV lead positioning

LV lead positioning guided by echocardiography (mechanical strain evaluation by speckle tracking) in combination with cardiac CT. A viable segment with the latest mechanical activation is targeted, and an appropriate "optimal" cardiac vein segment is then chosen using the CT images.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Symptomatic heart failure (New York Heart Association functional class II - IV) despite stabile optimal medical therapy.
* Wide QRS ≥ 120 milliseconds on standard ECG.
* LV systolic dysfunction (EF ≤ 35%).
* Written informed consent.
* Accepted for CRT-P or CRT-D treatment

Exclusion Criteria

* Life expectancy \< 12 months.
* Recent myocardial infarction (\< 3 months).
* Significant valve disease
* Chronic atrial fibrillation
* Pregnancy
* Severely impaired renal function (estimated glomerular filtration rate (eGFR) \< 30 ml/min)
* Unable to give written informed consent.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Crafoord Foundation

OTHER

Sponsor Role collaborator

Region Skane

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Rasmus Borgquist, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Region Skane

Locations

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Skane University Hospital

Lund, , Sweden

Site Status

Countries

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Sweden

References

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Borgquist R, Carlsson M, Markstad H, Werther-Evaldsson A, Ostenfeld E, Roijer A, Bakos Z. Cardiac Resynchronization Therapy Guided by Echocardiography, MRI, and CT Imaging: A Randomized Controlled Study. JACC Clin Electrophysiol. 2020 Oct;6(10):1300-1309. doi: 10.1016/j.jacep.2020.05.011. Epub 2020 Aug 12.

Reference Type DERIVED
PMID: 33092758 (View on PubMed)

Other Identifiers

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CRTCLIN01

Identifier Type: -

Identifier Source: org_study_id

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