Comparison of CRT-D and CRT-DX Systems (CRT-NEXT)

NCT ID: NCT03587064

Last Updated: 2023-11-15

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

RECRUITING

Clinical Phase

NA

Total Enrollment

640 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-10-22

Study Completion Date

2025-04-30

Brief Summary

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The principal objective is to test non-inferiority of the CRT-DX system as compared to a conventional CRT-D system, in terms of the combined endpoint of mortality, hospitalizations due cardiovascular causes, any complication leading to loss of lead functionality, in the subset of patients without evidence of sinus dysfunction on optimal therapy.

Detailed Description

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Resting heart rate is strongly associated with incident worsening Heart Failure (HF) and mortality. Current devices for cardiac resynchronization (CRT-D) normally provide atrio-ventricular (AV) sequential pacing modes during resynchronization, but the best pacing programming strategy is not clear.

On the one hand a basic rate of 50 to 70 bpm (optionally with some rate-responsive function) could be considered for therapy up-titration, specifically betablockers; on the other hand, increasing pacing rates may partially reduce benefits from resynchronization, reducing filling time and contractility reservoir.

The Pegasus investigation is the only large randomized investigation comparing DDD with 70 bpm basic rate to DDD(R) @40 bpm. Results showed no difference in investigation endpoints, including mortality and HF-hospitalization.

These results may support the use of a device implementing both a CRT function and a right ventricular single-lead with and an atrial sensing dipole (CRT-DX system). This system can track ventricular pacing and resynchronization following atrial sensing, even if it cannot provide atrial pacing support. It should be assessed whether such limitation is counterbalanced by the advantages related to the reduced number of necessary leads, with simplified implantation and less complications.

The objective of the investigation is to assess whether atrial pacing support is really necessary in the subset of patients with indication to CRT-D and no evidence of sinus dysfunction on optimal therapy. The investigation will test the hypothesis that a CRT-DX system is not inferior to a conventional CRT-D system in this class of subjects.

Conditions

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Heart Failure Cardiac Resynchronization Therapy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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3-lead CRT implantation (CRT-D)

In the 3-lead CRT implantation (CRT-D) group, conventional 3-lead CRT defibrillator system implantation will be performed. The CRT-D system is composed by three leads, one in atrium and two in both ventricles

Group Type ACTIVE_COMPARATOR

Conventional 3-lead CRT defibrillator system implantation

Intervention Type DEVICE

Conventional 3-lead(1 atrial and 2 ventricular leads) system implantation

2-lead CRT implantation (CRT-DX)

In the 2-lead CRT implantation (CRT-DX) group, 2-lead CRT defibrillator system implantation will be performed. The CRT-DX system is composed by two ventricular leads, the right one is provided with a dipole for atrial sensing

Group Type EXPERIMENTAL

2-lead CRT defibrillator system implantation

Intervention Type DEVICE

2-lead (2 ventricular leads with dipole for atrial sensing) DX system implantation

Interventions

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Conventional 3-lead CRT defibrillator system implantation

Conventional 3-lead(1 atrial and 2 ventricular leads) system implantation

Intervention Type DEVICE

2-lead CRT defibrillator system implantation

2-lead (2 ventricular leads with dipole for atrial sensing) DX system implantation

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

1. Male and female patients ≥ 18 years old
2. Patients willing to participate in the investigation and signing the Patient Informed Consent (PIC) Form;
3. Indication to CRT-D implant according to current ESC Guidelines on cardiac pacing and cardiac resynchronization therapy
4. Sinus rhythm at time of implant;
5. Optimized medical therapy according to current ESC Guidelines
6. Rest heart rate (HR) \>45 bpm at baseline ECG, with betablocker therapy at optimal medical dosage; or, if rest HR\<45 bpm: maximum heart rate at the 6- minute walking test \>85 bpm.

Exclusion Criteria

1. Any indication to atrial pacing according to current guidelines;
2. Both: resting heart rate \<45 bpm at baseline ECG, with betablocker therapy at optimal medical dosage and maximum heart rate at the 6-minute walking test \<85 bpm;
3. NYHA Class IV;
4. Permanent Atrial Fibrillation
5. Replacement of/upgrading from previously implanted pacing system;
6. Dialysis patients;
7. Pregnant or breast-feeding women.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Associazione Portatori Dispositivi Impiantabili Cardiaci

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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ASST Rhodense

Rho, Milano, Italy

Site Status RECRUITING

Ospedale di Camposampiero

Camposampiero, Padova, Italy

Site Status RECRUITING

AOU Ospedali Riuniti Ancona

Ancona, , Italy

Site Status RECRUITING

Azienda Ospedaliero-Universitaria di Bologna Policlinico S.Orsola Malpighi

Bologna, , Italy

Site Status RECRUITING

Fondazione Giovanni Paolo II

Campobasso, , Italy

Site Status RECRUITING

Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele - Presidio Ferrarotto

Catania, , Italy

Site Status RECRUITING

Clinica Sant'Anna

Catanzaro, , Italy

Site Status RECRUITING

Azienda Ospedaliera Pugliese Ciaccio

Catanzaro, , Italy

Site Status RECRUITING

Arcispedale Sant'Anna

Ferrara, , Italy

Site Status RECRUITING

Ospedale Santa Maria Nuova

Florence, , Italy

Site Status RECRUITING

Ospedale di Gorizia

Gorizia, , Italy

Site Status ACTIVE_NOT_RECRUITING

Ospedale Vito Fazzi

Lecce, , Italy

Site Status RECRUITING

Ospedale Mater Salutis di Legnago

Legnago, , Italy

Site Status RECRUITING

Ospedale Carlo Poma

Mantova, , Italy

Site Status RECRUITING

IRCSS - Centro Neurolesi Bonino Pulejo

Messina, , Italy

Site Status RECRUITING

Ospedale San Gerardo

Monza, , Italy

Site Status RECRUITING

AOU Vanvitelli - Monaldi

Napoli, , Italy

Site Status RECRUITING

AO dei Colli - PO Monaldi

Napoli, , Italy

Site Status RECRUITING

Ospedale Federico II

Napoli, , Italy

Site Status RECRUITING

Azienda Ospedaliero - Universitaria di Parma

Parma, , Italy

Site Status RECRUITING

Fondazione Toscana Gabriele Monasterio

Pisa, , Italy

Site Status RECRUITING

Ospedale Giovanni Paolo II

Ragusa, , Italy

Site Status RECRUITING

Ospedale Molinette

Torino, , Italy

Site Status RECRUITING

Ospedali Riuniti Trieste

Trieste, , Italy

Site Status RECRUITING

Countries

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Italy

Central Contacts

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Mauro Biffi, MD

Role: CONTACT

0516363434

Facility Contacts

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Giovanni Luca Botto, MD

Role: primary

Emanuele Bertaglia

Role: primary

Antonio Dello Russo, MD

Role: primary

Mauro Biffi, MD

Role: primary

Matteo Santamaria, MD

Role: primary

Valeria Calvi, MD

Role: primary

Tommaso Infusino, MD

Role: primary

Giampiero Maglia, MD

Role: primary

Matteo Bertini, MD

Role: primary

Andrea Giomi, MD

Role: primary

Ennio PisanĂ², MD

Role: primary

Gabriele Zanotto, MD

Role: primary

Patrizia Pepi, MD

Role: primary

Antonio Duca, MD

Role: primary

Giovanni Rovaris, MD

Role: primary

Vincenzo Russo

Role: primary

Antonio D'Onofrio, MD

Role: primary

Antonio Rapacciuolo, MD

Role: primary

Francesca Notarangelo, MD

Role: primary

Marcello Piacenti, MD

Role: primary

Antonio Nicosia, MD

Role: primary

Davide Castagno, MD

Role: primary

Massimo Zecchin, MD

Role: primary

Other Identifiers

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APDIC

Identifier Type: -

Identifier Source: org_study_id

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