Elimination of VPB With Ablation Versus Anti-arrhythmic Drug Treatment

NCT ID: NCT03845010

Last Updated: 2023-06-28

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

22 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-02-12

Study Completion Date

2023-01-17

Brief Summary

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The ECTOPIA trial is a randomized, multicenter, clinical trial to assess elimination of ventricular premature beats (VPB) with catheter ablation versus optimal anti-arrhythmic drugs (AAD) treatment with flecainide/verapamil or sotalol.

Detailed Description

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The ECTOPIA trial is a randomized, multicenter, clinical trial to assess elimination of VPB with catheter ablation versus optimal AAD treatment with flecainide/verapamil or sotalol. Due to the use of different AAD (with and without beta-blocking abilities) the investigators will be able to explore the secondary objectives. Finally, this study will assess safety of ablation of non-RVOT VPBs and long-term treatment with two different AAD.

Conditions

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Ventricular Premature Beats

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Randomized trial comparing catheter ablation with two different potent AADs with different engagement mechanisms in a 1:1:1 ratio with a crossover design in the AAD arm.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Sotalol

Group Type ACTIVE_COMPARATOR

Sotalol

Intervention Type DRUG

Patients will be titrated to the maximal tolerated dose of sotalol with a targeted dose of 80 thrice daily (TID)

Flecainide and verapamil

Group Type ACTIVE_COMPARATOR

Flecainide and verapamil

Intervention Type DRUG

Patients will receive maximal tolerated dose of flecainide and verapamil with titration to a maximal dose of 200 mg of flecainide and 240 mg of verapamil per day

Catheter ablation

Group Type ACTIVE_COMPARATOR

Catheter ablation

Intervention Type PROCEDURE

Patients will undergo VPB/VT ablation using a percutaneous transfemoral approach according to standard clinical routine

Interventions

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Sotalol

Patients will be titrated to the maximal tolerated dose of sotalol with a targeted dose of 80 thrice daily (TID)

Intervention Type DRUG

Flecainide and verapamil

Patients will receive maximal tolerated dose of flecainide and verapamil with titration to a maximal dose of 200 mg of flecainide and 240 mg of verapamil per day

Intervention Type DRUG

Catheter ablation

Patients will undergo VPB/VT ablation using a percutaneous transfemoral approach according to standard clinical routine

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Patients willing and capable to provide written informed consent
* Patients with frequent symptomatic VPB and/or nonsustained VTs with burden ≥ 5% on 24 hour Holter monitor AND
* Absence of structural heart disease (excluded by echocardiogram) AND
* Absence of underlying cardiac ischemia (ruled out by treadmill test, CT coronary arteries, nuclear scintigraphy or coronary angiography) AND
* Patient is considered an acceptable candidate for catheter ablation treatment with a dominant morphology of VPB/VT origin judged by the treating physician.
* For those already undergoing treatment, all antiarrhythmic drugs including digitalis must be discontinued during a 2-week washout period before entry to the study

Exclusion Criteria

* Age \>75 years
* Previous catheter ablation therapy for VPB/VT
* Patients with sustained ventricular tachycardia or cardiac channelopathies (e.g. Catecholaminergic polymorphic ventricular tachycardia (CPVT), long- or short QT syndrome, Brugada syndrome)
* Wolff-parkinson-white (WPW) syndrome
* Use of medication with risk of QTc prolongation (e.g. antidepressant, antiemetic), except for study medication sotalol.
* Left ventricular dysfunction (LV ejection fraction \<55%)
* Estimated glomerular filtration rate \< 50 ml/min/1.73 m2
* Hepatic impairment defined by a total bilirubin ≥ 2 times the upper limit (ULN) of normal, or alanine aminotransferase (ALAT) or aspartate aminotransferase (ASAT) ≥ 3 times ULN at screening
* Untreated hypo- or hyperthyroidism or electrolyte imbalance
* Untreated obstructive sleep apnea
* Patients with history of myocardial infarction or bypass surgery
* More than grade 1/3 valvular regurgitation and/or significant valve stenosis (moderate or severe)
* Contraindication for any of the antiarrhythmic drugs used in this study
* Enrolment in another clinical study
* Woman currently pregnant or breastfeeding or not using reliable contraceptive measures during fertile age
* Mental or physical inability to participate in the study
* Life expectancy ≤ 12 months
Minimum Eligible Age

76 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Maatschap Cardiologie Zwolle

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Arif Elvan, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Isala

Locations

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Isala hospital

Zwolle, , Netherlands

Site Status

Countries

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Netherlands

Other Identifiers

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10407

Identifier Type: -

Identifier Source: org_study_id

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