Neural Cardiac Therapy for Heart Failure Study (NECTAR-HF) (NECTAR-HF)
Heart Failure, Congestive Heart Failure
About this trial
This is an interventional treatment trial for Heart Failure focused on measuring Heart failure, Congestive heart failure, New York Heart Association Class II-III, Vagal therapy, Vagal nerve stimulation
Eligibility Criteria
Inclusion Criteria:
- Age 18 or above, and of legal age to give informed consent specific to national laws
- Willing and capable of providing informed consent
- Capable of participating in all testing associated with this clinical investigation
- Stable symptomatic heart failure NYHA class II-III
- Left ventricular (LV) ejection fraction equal or smaller than 35 %
- Left ventricular end diastolic diameter (LVEDD) of 5.5 cm or greater
- Prescribed to optimal pharmacologic therapy
Exclusion Criteria:
- QRS larger than 130 ms
- Patients who have been hospitalized for heart failure and who required the use of HF IV therapy within 30 days before enrollment
- Patients unable to tolerate anesthesia required for implant
- Patients with unstable angina, myocardial infarction, PTCA, coronary artery bypass graft, cerebral vascular accident, or transient ischemic attack within previous 90 days before enrollment
- Patients whose primary cause of heart failure is mitral or aortic valve disease, with a severe classification
- Patients with persistent or permanent atrial fibrillation within 90 days prior to enrollment
- Pacemaker indicated patients
- Patients whose heart failure is due to congenital heart disease
- Patients who have started treatment for sleep apnea or sleep disordered breathing with therapies to maintain airway patency (e.g., CPAP, Bi-PAP,APAP) with or without oxygen supplementation within the previous 6 months prior to enrollment
- Patients with hypertrophic obstructive cardiomyopathy or infiltrative cardiomyopathy (e.g. amyloidosis, sarcoidosis)
- Patients with documented chronic obstructive lung disease
- Patients on or indicated for renal dialysis
- Type 1 diabetic patients
- Type 2 diabetic patients that have been treated with insulin for more than 5 years prior to enrollment
- Patients with a life expectancy of less than 12 months per physician judgment
- Patients involved in any concurrent clinical investigation
- Women of childbearing potential who are or might be pregnant at the time of the study or breastfeeding
- Patients with a prior cardiac transplant or expecting a heart transplant operation within the next 12 months
- Patients with a prior vagotomy
- Patients with prior or existing vagal nerve stimulation treatment
- Patients implanted with any active implantable medical device other than a left sided single or dual chamber implantable cardioverter defibrillator (ICD) with bipolar sensing, or a left sided CRT device with each sensing channel programmed to either bipolar sensing or no sensing. All CRT patients must have had CRT for at least 1 year prior to enrollment. The total number of CRT patients will not exceed 30
- Patients with locally implanted semi-/permanent devices such as vascular catheters, etc. that would interfere with the NECTAR-HF study system
- Patients with previously implanted devices on the right side that became infected before removal
- Patients with previous neck surgery and resultant scar formation that interferes with the ability to implant the study system on the right side of the neck (Thyroid/parathyroid, carotid artery etc)
- Patients with known recurrent nerve paralysis
- Patients who have undergone radiotherapy for thyroid disease/cancer
- Patients who have existing or prior tracheotomy
- Patients with severe vertebral cervical disease and limited mobility in the neck; includes those that frequently wear a brace
- Patients with carotid murmur/vascular bruit/carotid artery lesion
- Patients with known/suspected vascular malformation in carotid/vertebral circulatory bed
- Patients who are likely to need an MRI of the neck area because of previous medical conditions
Sites / Locations
- UCL Bruxelles
- Nemocnice Na Homolce
- Centre d'Investigation Clinique Pierre Drouin, CHU de Nancy
- CHRU de Lille - Hôpital Cardiologique
- Immanuel Klinikum Bernau Herzzentrum Brandenburg
- Universitätsmedizin Göttingen
- Universitäres Herzzentrum GmbH, Universitätsklinikum Hamburg-Eppendorf
- Universitätsklinikum Leipzig
- Azienda Ospedaliera Niguarda Cà Granda
- A. O. Dei Colli - Monaldi
- Policlinico San Matteo
- Catharina Ziekenhuis Eindhoven
- UMC Utrecht
- Clínica Universitaria de Navarra, Avenida Pio XII s/n
- Hospital Clinic de Barcelona
- Hospital Doce de Octubre
- University Hospitals Bristol, NHS Foundation Trust
- Liverpool Heart and Chest Hospital, NHS Foundation Trust
- The Heart Hospital, University College London Hospitals, NHS Foundation Trust
- Imperial College Healthcare NHS Trust, St. Mary's Hospital
- King's College Hospital NHS Foundation Trust
Arms of the Study
Arm 1
Arm 2
Experimental
Sham Comparator
Therapy
Control
Implant of investigational device system for vagus nerve stimulation. Patients were randomized in a 2 : 1 ratio to receive therapy (VNS ON) or control (VNS OFF) for a 6-month period. The experimental arm was receiving vagus nerve stimulation during the first 6 months after implant. Titration during the randomization phase with delivery of highest tolerable by patient stimulation current. Blood Draw before implant and 6 months after implant. Titration after the randomization phase with adjustments of the chronically highest tolearble by patient current.
Implant of investigational device system for vagus nerve stimulation. Control group was implanted with study system like the experimental arm, but was not receiving experimental vagus nerve stimulation therapy during the first 6 months after implant. 6-month after implant a cross-over took place and the control arm also started to receive experimental vagus nerve stimulation. Blood Draw before implant and 6 months after implant. Titration after the randomization phase with adjustments of the chronically highest tolearble by patient current.