Permanent Pacemaker Implantation or Cardioneuroablation in Sinus Node Dysfunction

NCT ID: NCT05196126

Last Updated: 2023-03-07

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

UNKNOWN

Clinical Phase

NA

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-06-01

Study Completion Date

2024-06-30

Brief Summary

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This is a noncommercial, physician-initiated, monitored, multicenter, prospective randomized clinical trial, a proof-of-concept study, investigating a treatment strategy only. The study will use medical products applied for invasive and nonivasive procedures performed at the participating centers.

Detailed Description

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All patients meeting the inclusion criteria and not meeting the exclusion criteria will be invited to participate in the study. The patient will receive an informed consent form describing the study protocol. After speaking to the investigator and receiving detailed answers to all questions, the patient will sign the written informed consent form to participate in the study or will choose to opt out of randomization and to be included in the registry only.

Premenopausal women who will provide consent to participate in the study will undergo a pregnancy test before any invasive procedure. During the 12-month study duration, the use of effective contraception is recommended.

The patient will be asked to complete the questionnaires on bradycardia symptoms and quality of life (QOL).

Any patient included in the study will be randomized into group A or group B. Patients included in the registry (group C) will undergo patient-tailored interventions and treatments through shared decision-making with a possibility of permanent cardiac pacing (subgroup CA), vagal nerve stimulation (VNS) according to the protocol and cardioneuroablation (subgroup CB), as well as observation (subgroup CO).

Conditions

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Sinus Node Dysfunction

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Group A - PACEMAKER

According with ESC indications for elective pacemaker implantation due to SND will referred for PM implantation.

Group Type ACTIVE_COMPARATOR

Permament pacemaker implantation

Intervention Type PROCEDURE

PM implantation

Group B - CARDIONEUROABLATION

According with ESC indications for elective PM implantation due to SND will referred for ICM/ILR implantation or prolonged ECG monitoring. Within 4 weeks patient will be screened by interdisciplinary team and autonomic tests (including atropine tests) will be performed. Than, based on atropine tests, electrophysiologic study and extracardiac vagal nerve stimulation, final indication for cardioneuroablation will be established. Biatrial, binodal cardioneuroablation will be performed with anatomical approach with bilateral extra cardiac vagal nerve stimulation during general anesthesia. Than, patient will be closely monitored and indication for PM implantation will be verified.

Group Type EXPERIMENTAL

Cardioneuroablation

Intervention Type PROCEDURE

Biatrial, binodal CNA procedure with anatomical approach will be performed with pre- and post procedural extracardiac vagal nerve stimulation in general anesthesia.

Interventions

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Permament pacemaker implantation

PM implantation

Intervention Type PROCEDURE

Cardioneuroablation

Biatrial, binodal CNA procedure with anatomical approach will be performed with pre- and post procedural extracardiac vagal nerve stimulation in general anesthesia.

Intervention Type PROCEDURE

Other Intervention Names

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Extracardiac vagal nerve stimulation

Eligibility Criteria

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Inclusion Criteria

* Age, 18-75 years
* Sinus node dysfunction/disease fulfilling criteria for elective pacemaker implantation according to current ESC guidelines (I, IIa, and IIb )
* Optimization of chronic disease treatment
* Ability to provide informed consent to participate in the study
* Ability to understand patient information.

Exclusion Criteria

* Contraindications to invasive and noninvasive procedures used in the study
* Uncontrolled endocrine and systemic disorders
* Persistent atrial fibrillation
* Dilated cardiomyopathy
* Severe congenital heart valve disease or cardiomyopathy
* Functional NYHA class III/IV
* Left ventricular ejection fraction \<35%
* Left atrial diameter \>50 mm
* Previous catheter ablation
* Contraindications to anticoagulant treatment
* Contraindications to catheter ablation
* Chronic, advanced two- or third-degree atrioventricular block associated with structural heart disease
* Contraindications to noninvasive tests
* Pregnancy and lactation
* Previous cardiac surgery
* Implanted pacemaker device
* Neck and chest abnormalities
* Myocardial infarction in the previous 6 months
* Percutaneous coronary intervention in the previous 3 months
* Estimated survival \<24 months
* Participation in another drug or medical device program
* Limited capacity to understand the study protocol or psychological disorders precluding informed consent to participate in the study.
* Any other uncontrolled chronic diseases, neck and chest abnormalities, or disorders that constitute a contraindication to catheter ablation, antiarrhytmic treatment, general anesthesia, or extracardiac vagal nerve stimulation (ECANS)
* Severe obesity (body mass index ≥40 kg/m2 )
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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KCRI

OTHER

Sponsor Role collaborator

Stec, Sebastian, MD, PhD, FESC

OTHER

Sponsor Role lead

Responsible Party

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Sebastian Stec

Stec Sebastian MD, PhD, FESC

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Sebastian Stec, MD, PhD

Role: STUDY_CHAIR

Medical Center SABAMED Medicans

Locations

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Center of Interventional Cardiology, Electrotherapy and Angiology G.V.M. Carint

Ostrowiec Świętokrzyski, , Poland

Site Status NOT_YET_RECRUITING

Medical Center SABAMED

Rzeszów, , Poland

Site Status RECRUITING

Subcarpatian Center for Cardiovascular Interventions, Laboratory of Electrophysiology, Cardioneuroablation, Ablation, Arrhythmia and Heart Electrostimulation, G.V.M. Carint

Sanok, , Poland

Site Status RECRUITING

Department of Cardiology, Laboratory of Invasive Electrophysiology, 4th Military Teaching Hospital in Wroclaw

Wroclaw, , Poland

Site Status NOT_YET_RECRUITING

Countries

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Poland

Central Contacts

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Sebastian Stec, MD, PhD

Role: CONTACT

+48600298022

Edyta Stodółkiewicz-Nowarska, MD PhD

Role: CONTACT

785885425

Facility Contacts

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Janusz Sledz, MD

Role: primary

+48 602535589

Agnieszka Reichert, MD

Role: primary

+48 69365129

Antoni Wileczek, MD

Role: primary

+48 663517874

Adrianna Szalonka, BA

Role: primary

+48 535502175

Other Identifiers

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SANOK

Identifier Type: -

Identifier Source: org_study_id

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