An Arrhythmia Risk Predictor Trial

NCT02010515 | Completed

• 1 other identifier: UMG-181211
• Study Type: observational
• Target: 282
• Locations: 1 country
• Sites: 1

Brief Summary

This prospective single-center study is an observational risk stratification trial in about 250 patients with standard indications for ICD treatment. Implantable cardioverter defibrillators (ICD) have been shown to improve survival and current guidelines recommend their use for primary and secondary prevention of sudden cardiac death (SCD). However, a large number of patients never receive an appropriate therapy from their device. In contrast, electrical sorm and multiple ICD shocks occur in other patients. Thus, identification of predictors for survival or ICD shocks is necessary for improved patient selection and optimized therapeutic strategies. Risk stratification with electrocardiogram (ECG) and signal averaged ECG (SAECG), T-wave alternans (TWA) and Holter ECG including premature ventricular contractions (PVC), non-sustained VT (nsVT), heart rate variability (HRV), heart rate turbulence (HRT) and deceleration capacity, as well as clinical variables is possible, but not implemented in clinical routine in patients with ischemic or dilated cardiomyopathy and newly implanted ICD for primary or secondary prevention of SCD following current guidelines. Patients will be prospectively followed and the predictive value of the risk markers mentioned above to predict all-cause mortality or appropriate ICD shocks will be investigated.

Conditions

Cardiomyopathy; Heart Failure

Keywords

sudden cardiac death; risk stratification; t-wave alternans; Holter electrocardiography; heart rate turbulence

Outcome Measures

Primary Outcomes (2)

• All-Cause Mortality

  2008-2013

• First Appropriate ICD Shock

  First ICD discharge for malignant ventricular arrhythmia

  2008-2013

Study Arms (1)

Sinus rhythm, first ICD implantation

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patients with ischemic or dilated cardiomyopathy and "standard indications" for ICD treatment. "Stamdard indications" are approved and strictly follow current guidelines, the decision on ICD implantation is based on left-ventricular ejection fraction or the history of malignant arrhythmia. i.e. secondary prevention of sudden cardiac death). Implantation procedure is performed at University Medical Center Goettingen.

You may qualify if:

• ischemic or dilated cardiomyopathy
• sinusrhythm
• ICD indication strictly following current guidelines (primary and secondary prevention of SCD)
• Age 18 years or older

You may not qualify if:

• no consent
• atrial fibrillation

Sponsors & Collaborators

• University Medical Center Goettingen: lead

Study Sites (1)

University Medical Center Goettingen

Göttingen, 37075, Germany

Location

Related Publications (9)

• Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, Gregoratos G, Klein G, Moss AJ, Myerburg RJ, Priori SG, Quinones MA, Roden DM, Silka MJ, Tracy C, Smith SC Jr, Jacobs AK, Adams CD, Antman EM, Anderson JL, Hunt SA, Halperin JL, Nishimura R, Ornato JP, Page RL, Riegel B, Blanc JJ, Budaj A, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL; American College of Cardiology/American Heart Association Task Force; European Society of Cardiology Committee for Practice Guidelines; European Heart Rhythm Association; Heart Rhythm Society. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006 Sep 5;114(10):e385-484. doi: 10.1161/CIRCULATIONAHA.106.178233. Epub 2006 Aug 25. No abstract available.

  PMID: 16935995 BACKGROUND

• Tung R, Zimetbaum P, Josephson ME. A critical appraisal of implantable cardioverter-defibrillator therapy for the prevention of sudden cardiac death. J Am Coll Cardiol. 2008 Sep 30;52(14):1111-21. doi: 10.1016/j.jacc.2008.05.058.

  PMID: 18804736 BACKGROUND

• Buxton AE, Lee KL, Hafley GE, Pires LA, Fisher JD, Gold MR, Josephson ME, Lehmann MH, Prystowsky EN; MUSTT Investigators. Limitations of ejection fraction for prediction of sudden death risk in patients with coronary artery disease: lessons from the MUSTT study. J Am Coll Cardiol. 2007 Sep 18;50(12):1150-7. doi: 10.1016/j.jacc.2007.04.095. Epub 2007 Sep 4.

  PMID: 17868806 BACKGROUND

• Hohnloser SH, Ikeda T, Bloomfield DM, Dabbous OH, Cohen RJ. T-wave alternans negative coronary patients with low ejection and benefit from defibrillator implantation. Lancet. 2003 Jul 12;362(9378):125-6. doi: 10.1016/s0140-6736(03)13865-2.

  PMID: 12867114 BACKGROUND

• Buckingham TA, Thessen CC, Stevens LL, Redd RM, Kennedy HL. Effect of conduction defects on the signal-averaged electrocardiographic determination of late potentials. Am J Cardiol. 1988 Jun 1;61(15):1265-71. doi: 10.1016/0002-9149(88)91167-8.

  PMID: 3376884 BACKGROUND

• Bigger JT Jr, Fleiss JL, Kleiger R, Miller JP, Rolnitzky LM. The relationships among ventricular arrhythmias, left ventricular dysfunction, and mortality in the 2 years after myocardial infarction. Circulation. 1984 Feb;69(2):250-8. doi: 10.1161/01.cir.69.2.250.

  PMID: 6690098 BACKGROUND

• Schmidt G, Malik M, Barthel P, Schneider R, Ulm K, Rolnitzky L, Camm AJ, Bigger JT Jr, Schomig A. Heart-rate turbulence after ventricular premature beats as a predictor of mortality after acute myocardial infarction. Lancet. 1999 Apr 24;353(9162):1390-6. doi: 10.1016/S0140-6736(98)08428-1.

  PMID: 10227219 BACKGROUND

• Bauer A, Kantelhardt JW, Barthel P, Schneider R, Makikallio T, Ulm K, Hnatkova K, Schomig A, Huikuri H, Bunde A, Malik M, Schmidt G. Deceleration capacity of heart rate as a predictor of mortality after myocardial infarction: cohort study. Lancet. 2006 May 20;367(9523):1674-81. doi: 10.1016/S0140-6736(06)68735-7.

  PMID: 16714188 BACKGROUND

• Seegers J, Bergau L, Exposito PM, Bauer A, Fischer TH, Luthje L, Hasenfuss G, Friede T, Zabel M. Prediction of Appropriate Shocks Using 24-Hour Holter Variables and T-Wave Alternans After First Implantable Cardioverter-Defibrillator Implantation in Patients With Ischemic or Nonischemic Cardiomyopathy. Am J Cardiol. 2016 Jul 1;118(1):86-94. doi: 10.1016/j.amjcard.2016.04.016. Epub 2016 Apr 22.

  PMID: 27189815 DERIVED

MeSH Terms

Conditions

Cardiomyopathies; Heart Failure; Death, Sudden, Cardiac

Condition Hierarchy (Ancestors)

Heart Diseases; Cardiovascular Diseases; Heart Arrest; Death, Sudden; Death; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Markus Zabel, M.D.

  University Medical Center Goettingen

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: CASE ONLY
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor, Head of Clinical Electrophysiology

Study Record Dates

• First Submitted: December 9, 2013
• First Posted: December 12, 2013
• Study Start: January 1, 2008
• Primary Completion: May 1, 2013
• Study Completion: May 1, 2013
• Last Updated: December 12, 2013

Record last verified: 2013-12

Locations

DE (1)