Optimal Pacing Rate for Cardiac Resynchronization Therapy

NCT ID: NCT06445439

Last Updated: 2024-10-15

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

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-12-19

Study Completion Date

2025-08-31

Brief Summary

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This is a prospective, randomized crossover study. The objective of the study is to determine if a pacing rate of 80 beats per minute (bpm) improves exercise tolerance during the 6-minute walk test. The investigators will randomly assign half of the participants to a starting rate of 60 bpm and then switch them to a rate of 80 bpm for 3 months, and vice versa.

Detailed Description

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Cardiac resynchronization therapy (CRT) after atrioventricular node (AVN) ablation for permanent atrial fibrillation (AF) has led to better outcomes in heart failure (HF) patients with reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF) compared to pharmacotherapy. Emerging evidence has demonstrated patients with HFpEF may benefit from a higher heart rate compared to standard heart-lowering therapies. The optimal pacing rate for CRT after AVN ablation in persistent AF and HFpEF remains unknown.

This is a prospective, randomized crossover study. The objective of the study is to determine if a pacing rate of 80 beats per minute (bpm) improves exercise tolerance during the 6-minute walk test.

The investigators will randomly assign half of the participants to a starting rate of 60 bpm and then switch them to a rate of 80 bpm for 3 months, and vice versa. Patient mortality and HF hospitalizations will be recorded at each phase. An electrocardiogram, echocardiogram, pacemaker interrogation, BNP and creatinine levels, KCCQ-12, six-minute walk test, and physical activity measure will be obtained at baseline, 3 months, and 6 months.

Conditions

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Atrial Fibrillation, Persistent

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

The investigators will randomly assign half of the participants to a starting rate of 60 bpm and then switch them to a rate of 80 bpm for 3 months, and vice versa.
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors

Study Groups

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60 bpm, then 80 bpm

Pacing rate of 60 bpm for the first 3 months, then switch to 80 bpm for the next 3 months.

Group Type EXPERIMENTAL

Pacing rate of 80 bpm

Intervention Type DEVICE

Pacing rate of 80 bpm

Pacing rate of 60 bpm

Intervention Type DEVICE

Pacing rate of 60 bpm

80 bpm, then 60 bpm

Pacing rate of 80 bpm for the first 3 months, then switch to 60 bpm for the next 3 months.

Group Type EXPERIMENTAL

Pacing rate of 80 bpm

Intervention Type DEVICE

Pacing rate of 80 bpm

Pacing rate of 60 bpm

Intervention Type DEVICE

Pacing rate of 60 bpm

Interventions

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Pacing rate of 80 bpm

Pacing rate of 80 bpm

Intervention Type DEVICE

Pacing rate of 60 bpm

Pacing rate of 60 bpm

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

1. Age 18 years or older
2. History of persistent or permanent atrial fibrillation
3. Implantation of CRT or conduction system pacing in prior 3 months to 5 years of study start
4. History of intrinsic AVN block or have undergone AVN ablation in prior 3 months to 5 years of study start
5. LVEF ≥ 50%
6. N-terminal pro-B-type natriuretic peptide (NT-proBNP) \>400 pg/mL in the last 24 months
7. Clinical HF diagnosis or NYHA class II or higher
8. Able to provide informed consent

Exclusion Criteria

1. LVEF \<50%
2. Wide QRS (greater than 150ms)
3. Isolated RV pacing
4. Severe valvular disease
5. Severe coronary artery disease as defined by one of the following:

1. ACS or PCI within 1 year
2. Any angina (CCS class 1+)
3. Unrevascularizable severe CAD (\>70% stenosis in 1+ major vessels and/or based on functional assessment)
6. ESRD
7. Significant primary pulmonary disease on home oxygen
8. Major orthopedic issues, such as being wheelchair bound and/or unable to perform a six-minute walk test
9. Ventricular ectopy \>15% premature ventricular contractions (PVC)
10. End stage cancer diagnosis
11. Life expectancy less than one year
12. Palliative or hospice care
13. Hypertrophic cardiomyopathy (HCM)
14. Uncorrected ventricular septal defect
15. Infiltrative cardiomyopathy (CM)
16. Uncontrolled hypertension as defined by blood pressure \>160/100 mm Hg on two measurements ≥15 minutes apart
17. Hemoglobin \<7 g/dL
18. Age \>90 years old
19. Pregnant or intends to become pregnant
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Medtronic

INDUSTRY

Sponsor Role collaborator

Medstar Health Research Institute

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Athanasios Thomaides, MD

Role: PRINCIPAL_INVESTIGATOR

MedStar Health

Locations

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MedStar Georgetown University Hospital

Washington D.C., District of Columbia, United States

Site Status RECRUITING

MedStar Washington Hospital Center

Washington D.C., District of Columbia, United States

Site Status RECRUITING

MedStar Union Memorial Hospital

Baltimore, Maryland, United States

Site Status NOT_YET_RECRUITING

MedStar Southern Maryland Hospital

Clinton, Maryland, United States

Site Status RECRUITING

MedStar Heart and Vascular Office at Fairfax

Fairfax, Virginia, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Sarahfaye Dolman

Role: CONTACT

302-530-1873

Facility Contacts

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Sarahfaye Dolman

Role: primary

3025301873

Athanasios Thomaides, MD

Role: backup

Sarahfaye Dolman

Role: primary

3025301873

Athanasios Thomaides, MD

Role: backup

Sarahfaye Dolman, MPH

Role: primary

302-530-1873

Athanasios Thomaides, MD

Role: backup

Sarahfaye Dolman

Role: primary

3025301873

Athanasios Thomaides, MD

Role: backup

Sarahfaye Dolman

Role: primary

3025301873

Athanasios Thomaides, MD

Role: backup

Other Identifiers

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STUDY00006952

Identifier Type: -

Identifier Source: org_study_id

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