search
Back to results

Pan-Asia United States PrEvention of Sudden Cardiac Death Catheter Ablation Trial (PAUSE-SCD)

Primary Purpose

Ventricular Tachycardia (VT)

Status
Completed
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
Implantable Cardioverter Defibrillator (ICD)
Catheter Ablation
Sponsored by
University of Arizona
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Ventricular Tachycardia (VT) focused on measuring Sudden Cardiac Death, ICD Therapy, VT Ablation

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patient is receiving a new implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy device (CRT-D) implant that has study required programing capabilities and is appropriate for remote monitoring. Patient who has received the ICD / CRT-D within 90 days of enrollment can also be enrolled.
  • Patient who has a high risk of ICD shock as shown by documented Monomorphic VT (MMVT) by one or more of the following:

    • Spontaneous MMVT
    • Inducible MMVT during electrophysiology study,
    • Inducible MMVT during noninvasive programmed stimulation study *Inducible MMVT is defined as MMVT > 30 seconds or requiring electrical termination (ATP or cardioversion)
  • Patient has ejection fraction < 50% or right ventricular dysfunction
  • Patient has a cardiomyopathy with structural heart disease of any cause

Exclusion Criteria:

  • Any history of debilitating stroke with neurologic deficit
  • ST-segment elevation myocardial infarction or previous cardiac surgery within 60 days prior to enrollment
  • Patient is pregnant or nursing
  • Patient has chronic New York Heart Association (NYHA) class IV heart failure
  • Patient has incessant VT necessitating immediate treatment
  • Patient has ventricular tachycardia/ventricular fibrillation thought to be from channelopathies
  • Limited life expectancy (less than one year)
  • Patient has current class IV angina
  • Recent coronary artery bypass graft or percutaneous coronary intervention (< 45 days)
  • Patient is currently participating in another investigational drug or device study
  • Known presence of intracardiac thrombi
  • Prosthetic mitral or aortic valve or mitral or aortic valvular heart disease requiring immediate surgical intervention
  • Major contraindication to anticoagulation therapy or coagulation disorder
  • Left Ventricular Ejection Fraction < 15%
  • Patient has had a previous ablation procedure for VT, excluding remote (> 3 months) outflow tract tachycardia
  • Patient has glomerular filtration rate (GFR) < 30 mL/min/1.73m2
  • Patient has peripheral vascular disease that precludes left ventricular access
  • Patient is thought to have idiopathic outflow VT as only VT
  • Patient has a premature ventricular contraction (PVC) or VT induced cardiomyopathy that is expected to resolve with ablation and will not require an ICD
  • Patient has reversible cause of VT
  • Patient does not meet criteria for ICD or CRT-D

Sites / Locations

  • Banner University Medical Center Phoenix
  • Fuwai Cardiovascular Hospital
  • Huaxi Hospital
  • Guangdong General Hospital
  • Sir Run Run Shaw Hospital
  • Nanjing First Affiliated Hospital
  • PLA Shenyang General Hospital
  • Dokkyo Medical University, Saitama Medical Center
  • Kyorin University Hospital
  • Tsukuba University
  • Korea University
  • Taipei Veterans General Hospital

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Active Comparator

Active Comparator

Arm Label

ICD with Ablation

ICD Only

Ablation Only (Registry)

Arm Description

Patient will receive an implantable cardioverter defibrillator (ICD) with catheter ablation and standard medical management.

Patient will receive an implantable cardioverter defibrillator (ICD) and standard medical management.

The registry will enroll patients who refuse an implantable cardioverter defibrillator (ICD) and are thus not randomized. This arm will assess the efficacy of catheter ablation in the absence of background ICD therapy.

Outcomes

Primary Outcome Measures

Freedom From Recurrent VT, Cardiovascular Rehospitalization, and All-cause Mortality
The primary endpoint is a composite.

Secondary Outcome Measures

Freedom From Recurrent VT
Recurrent VT is defined as any appropriate ICD therapy (shock or ATP) or documented sustained monomorphic VT >30 seconds.
Freedom From Cardiovascular Rehospitalization
Cardiovascular rehospitalization is defined as a hospital admission after the randomized procedure for heart failure, procedure-associated complication, or arrhythmia-related causes during the follow-up period.
Freedom From All-cause Mortality

Full Information

First Posted
July 26, 2016
Last Updated
November 15, 2022
Sponsor
University of Arizona
search

1. Study Identification

Unique Protocol Identification Number
NCT02848781
Brief Title
Pan-Asia United States PrEvention of Sudden Cardiac Death Catheter Ablation Trial
Acronym
PAUSE-SCD
Official Title
PAUSE-SCD: Pan-Asia United States PrEvention of Sudden Cardiac Death Catheter Ablation Trial
Study Type
Interventional

2. Study Status

Record Verification Date
March 2022
Overall Recruitment Status
Completed
Study Start Date
November 30, 2015 (Actual)
Primary Completion Date
March 29, 2021 (Actual)
Study Completion Date
March 29, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Arizona

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The current standard of care for ventricular tachycardia (VT) includes the use of medicine called anti-arrhythmic drugs (AADs) and Implantable Cardioverter Defibrillator (ICD) therapy. These treatments are used to terminate the irregular heartbeats and bring the heart back to a normal rhythm. Catheter ablation is a procedure used to eliminate (damage) the heart cells causing the arrhythmia. Patients eligible for this may benefit from an ablation procedure in addition to an ICD to treat their VT condition or risk of developing VT. This study aims to show that treating VT with catheter ablation, if performed preemptively at the time of ICD implantation, will reduce subsequent recurrent VT, ICD shocks, and lead to improved survival.
Detailed Description
Subjects who meet inclusion/exclusion criteria will be entered into the randomized trial. Randomization will be 1:1 between control group and ablation group. Those randomized to the control group will receive ICD therapy and routine drug therapy (including antiarrhythmic drugs as indicated). Subjects randomized to the ablation group will receive ablation therapy plus ICD for ventricular tachycardia. Patients that refuse ICD therapy and undergo ablation only will be enrolled in a prospective registry. Follow-up will be performed prior to hospital discharge for incision check and device interrogation as is standard of care. In addition, routine device and clinical follow-up will be scheduled at 1, 3, 6, 12, 18, and 24 months. Electrocardiography (ECG) will be performed pre-implant and prior to hospital discharge. Echocardiography (TTE) will be performed pre-implant and at 12 and 24 months. Patients that refuse ICD implantation will not be randomized and will be approached for inclusion into a registry if they undergo catheter ablation without an ICD. Basic demographics and medical history will be collected from registry subjects upon enrollment. Registry subjects will receive follow-up for routine clinical care every 6 months to check on their overall status. 120 subjects will be randomized. An additional 60 subjects will enrolled into the registry. As of the time protocol revision C changes were made (07Nov2016), 33 subjects have been randomized. There has not been any preliminary or interim analysis of any data at this point. The study-sponsor has not had any access to any clinical follow-up for the patients enrolled to date.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Ventricular Tachycardia (VT)
Keywords
Sudden Cardiac Death, ICD Therapy, VT Ablation

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
180 (Actual)

8. Arms, Groups, and Interventions

Arm Title
ICD with Ablation
Arm Type
Experimental
Arm Description
Patient will receive an implantable cardioverter defibrillator (ICD) with catheter ablation and standard medical management.
Arm Title
ICD Only
Arm Type
Active Comparator
Arm Description
Patient will receive an implantable cardioverter defibrillator (ICD) and standard medical management.
Arm Title
Ablation Only (Registry)
Arm Type
Active Comparator
Arm Description
The registry will enroll patients who refuse an implantable cardioverter defibrillator (ICD) and are thus not randomized. This arm will assess the efficacy of catheter ablation in the absence of background ICD therapy.
Intervention Type
Device
Intervention Name(s)
Implantable Cardioverter Defibrillator (ICD)
Intervention Description
An ICD is a battery-powered device placed under the skin that keeps track of heart rate. Thin wires connect the ICD to the heart. If an abnormal heart rhythm is detected, the device will deliver an electric shock to restore a normal heartbeat.
Intervention Type
Procedure
Intervention Name(s)
Catheter Ablation
Intervention Description
Catheter ablation is a procedure that uses radiofrequency energy to destroy a small area of heart tissue that is causing rapid and irregular heartbeats. Destroying this tissue helps restore the heart's regular rhythm.
Primary Outcome Measure Information:
Title
Freedom From Recurrent VT, Cardiovascular Rehospitalization, and All-cause Mortality
Description
The primary endpoint is a composite.
Time Frame
2 years
Secondary Outcome Measure Information:
Title
Freedom From Recurrent VT
Description
Recurrent VT is defined as any appropriate ICD therapy (shock or ATP) or documented sustained monomorphic VT >30 seconds.
Time Frame
2 years
Title
Freedom From Cardiovascular Rehospitalization
Description
Cardiovascular rehospitalization is defined as a hospital admission after the randomized procedure for heart failure, procedure-associated complication, or arrhythmia-related causes during the follow-up period.
Time Frame
2 years
Title
Freedom From All-cause Mortality
Time Frame
2 years
Other Pre-specified Outcome Measures:
Title
Comparison of Outcomes in Ablation Only Registry With Randomized Patients
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient is receiving a new implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy device (CRT-D) implant that has study required programing capabilities and is appropriate for remote monitoring. Patient who has received the ICD / CRT-D within 90 days of enrollment can also be enrolled. Patient who has a high risk of ICD shock as shown by documented Monomorphic VT (MMVT) by one or more of the following: Spontaneous MMVT Inducible MMVT during electrophysiology study, Inducible MMVT during noninvasive programmed stimulation study *Inducible MMVT is defined as MMVT > 30 seconds or requiring electrical termination (ATP or cardioversion) Patient has ejection fraction < 50% or right ventricular dysfunction Patient has a cardiomyopathy with structural heart disease of any cause Exclusion Criteria: Any history of debilitating stroke with neurologic deficit ST-segment elevation myocardial infarction or previous cardiac surgery within 60 days prior to enrollment Patient is pregnant or nursing Patient has chronic New York Heart Association (NYHA) class IV heart failure Patient has incessant VT necessitating immediate treatment Patient has ventricular tachycardia/ventricular fibrillation thought to be from channelopathies Limited life expectancy (less than one year) Patient has current class IV angina Recent coronary artery bypass graft or percutaneous coronary intervention (< 45 days) Patient is currently participating in another investigational drug or device study Known presence of intracardiac thrombi Prosthetic mitral or aortic valve or mitral or aortic valvular heart disease requiring immediate surgical intervention Major contraindication to anticoagulation therapy or coagulation disorder Left Ventricular Ejection Fraction < 15% Patient has had a previous ablation procedure for VT, excluding remote (> 3 months) outflow tract tachycardia Patient has glomerular filtration rate (GFR) < 30 mL/min/1.73m2 Patient has peripheral vascular disease that precludes left ventricular access Patient is thought to have idiopathic outflow VT as only VT Patient has a premature ventricular contraction (PVC) or VT induced cardiomyopathy that is expected to resolve with ablation and will not require an ICD Patient has reversible cause of VT Patient does not meet criteria for ICD or CRT-D
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Roderick Tung, MD
Organizational Affiliation
University of Chicago
Official's Role
Study Director
Facility Information:
Facility Name
Banner University Medical Center Phoenix
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85006
Country
United States
Facility Name
Fuwai Cardiovascular Hospital
City
Beijing
Country
China
Facility Name
Huaxi Hospital
City
Chengdu
Country
China
Facility Name
Guangdong General Hospital
City
Guangzhou
Country
China
Facility Name
Sir Run Run Shaw Hospital
City
Hangzhou
Country
China
Facility Name
Nanjing First Affiliated Hospital
City
Nanjing
Country
China
Facility Name
PLA Shenyang General Hospital
City
Shenyang
Country
China
Facility Name
Dokkyo Medical University, Saitama Medical Center
City
Saitama
Country
Japan
Facility Name
Kyorin University Hospital
City
Tokyo
Country
Japan
Facility Name
Tsukuba University
City
Tsukuba
Country
Japan
Facility Name
Korea University
City
Seoul
Country
Korea, Republic of
Facility Name
Taipei Veterans General Hospital
City
Taipei
Country
Taiwan

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
35507499
Citation
Tung R, Xue Y, Chen M, Jiang C, Shatz DY, Besser SA, Hu H, Chung FP, Nakahara S, Kim YH, Satomi K, Shen L, Liang E, Liao H, Gu K, Jiang R, Jiang J, Hori Y, Choi JI, Ueda A, Komatsu Y, Kazawa S, Soejima K, Chen SA, Nogami A, Yao Y; PAUSE-SCD Investigators. First-Line Catheter Ablation of Monomorphic Ventricular Tachycardia in Cardiomyopathy Concurrent With Defibrillator Implantation: The PAUSE-SCD Randomized Trial. Circulation. 2022 Jun 21;145(25):1839-1849. doi: 10.1161/CIRCULATIONAHA.122.060039. Epub 2022 May 4.
Results Reference
derived
PubMed Identifier
31698933
Citation
Kheiri B, Barbarawi M, Zayed Y, Hicks M, Osman M, Rashdan L, Kyi HH, Bachuwa G, Hassan M, Stecker EC, Nazer B, Bhatt DL. Antiarrhythmic Drugs or Catheter Ablation in the Management of Ventricular Tachyarrhythmias in Patients With Implantable Cardioverter-Defibrillators: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Circ Arrhythm Electrophysiol. 2019 Nov;12(11):e007600. doi: 10.1161/CIRCEP.119.007600. Epub 2019 Nov 8.
Results Reference
derived

Learn more about this trial

Pan-Asia United States PrEvention of Sudden Cardiac Death Catheter Ablation Trial

We'll reach out to this number within 24 hrs