A Clinical Trial Utilizing Dantrolene in Patients With Ventricular Arrhythmias.

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2/PHASE3

Total Enrollment

68 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-08-21

Study Completion Date

2025-08-29

Brief Summary

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This is a randomized, placebo-controlled trial of Dantrolene (N= 84 participants) to demonstrate the feasibility of using intravenous (IV) dantrolene to study the effect of RyR2 inhibition on cardiac electrophysiology, hemodynamics, and ventricular arrhythmia inducibility in patients with structural heart disease referred for Ventricular Tachycardia (VT) ablation. The investigators will also explore the pharmacokinetic/pharmacodynamic relationship of IV dantrolene and its short-term effect on specific cardiac electrophysiologic and hemodynamic parameters.

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Detailed Description

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The hypothesis to be tested is that RyR2 hyperactivity in patients with structural heart disease drives proarrhythmic changes in refractoriness and conduction, and decreases cardiac contractility, which promotes Ventricular Tachycardia/Ventricular Fibrillation (VT/VF). Dantrolene, a currently available drug that inhibits RyR2, but has no Sodium (Na) or potassium (K) channel activity, will be used as a tool to study RyR2 modulation. The investigators propose a randomized controlled trial of dantrolene versus placebo in patients with structural heart disease referred for VT ablation to evaluate electrophysiologic, hemodynamic, and arrhythmia prevention endpoints. Dantrolene's inhibition of RyR1 will also be studied to define its effect on muscle and respiratory strength in this clinical population, which will be important if dantrolene is to be considered for repurposing as an antiarrhythmic drug.

The two aims are:

Aim 1: To conduct a randomized, placebo-controlled trial of dantrolene to study the effect of RyR inhibition on cardiac electrophysiology, hemodynamics, arrhythmia inducibility, muscle strength, and respiratory mechanics in patients with structural heart disease referred for Ventricular Tachycardia (VT) ablation.

Aim 2: To explore the pharmacokinetic/pharmacodynamic relationship of IV dantrolene and its short-term effect on cardiac electrophysiology, hemodynamics, and muscle and respiratory strength.

Conditions

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Ventricular Tachycardia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

84 participants will be randomly assigned in a 2:1 ratio to treatment (dantrolene) or control (placebo). A computer-generated randomization list will be prepared by the study statistician using the stratified permuted block randomization, where block size varies randomly from 4 or 6 to ensure overall balance across treatment arms. Randomization will be stratified by 1) documented CAD with prior infarct, 2) amiodarone use within the past 21 days defined as chronic oral use or \>5 grams cumulative, 3) LVEF \<35%. Enrollment will be evenly distributed across the two study arms by the stratification factors

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators

The study statistician will generate the allocation schedule but will remain blinded to the treatment assignment as well as the study staff physician's. The research clinician will not be blinded.

Study Groups

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Dantrolene/Ryanodex

Dantrolene/Ryanodex; intravenous administration of dantrolene; 1 mg/ kg IV over 3 minute, one time dose

Group Type EXPERIMENTAL

Dantrolene/Ryanodex

Intervention Type DRUG

muscle relaxant

Placebo

controlled placebo of saline administered Intravenous; 1 mg/kg IV over 3 minutes, one time dose

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type DRUG

Controlled placebo of saline administered Intravenous; 1 mg/kg IV over 3 minutes, one time dose

Interventions

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Dantrolene/Ryanodex

muscle relaxant

Intervention Type DRUG

Placebo

Controlled placebo of saline administered Intravenous; 1 mg/kg IV over 3 minutes, one time dose

Intervention Type DRUG

Other Intervention Names

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Dantrium, Ryanodex

Eligibility Criteria

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Inclusion Criteria

* Greater than or equal to 18 years of age
* Able to give written informed consent
* Referred for catheter-based VT ablation
* Structural heart disease (cardiomyopathy or RV/LV scar)
* Permanent pacemaker or implantable cardioverter defibrillator

Exclusion Criteria

* Mechanical ventricular support (e.g. LVAD, ECMO)
* NYHA class IV heart failure
* LVEF \< 20%
* Morbid obesity (BMI \> 40 kg/m2)
* Severe renal insufficiency (GFR\<30 mL/min)
* Chronic liver disease (Child Pugh class A-C)
* Current use of calcium channel blockers
* Neuromuscular disorder (e.g. muscular dystrophy)
* Chronic obstructive pulmonary disease or restrictive lung disease requiring oxygen
* Therapy or history of intubation
* Pregnant or nursing
* History of dysphagia

Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No