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Permanent Pacing for Drug-refractory Symptomatic Patients With Obstructive Hypertrophic Cardiomyopathy. (PACE-OHCM)

Primary Purpose

Obstructive Hypertrophic Cardiomyopathy

Status
Recruiting
Phase
Not Applicable
Locations
Italy
Study Type
Interventional
Intervention
pace maker implant guided by acute hemodynamic testing
Sponsored by
Istituto Auxologico Italiano
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Obstructive Hypertrophic Cardiomyopathy

Eligibility Criteria

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

Inclusion Criteria: unequivocal diagnosis of HCM, on the basis of 2-dimensional echocardiographic demonstration of a hypertrophied (wall thickness >15 mm or > 13 mm in familial HOCM) and non dilated LV in the absence of another cardiac or systemic disease capable of producing the same magnitude of hypertrophy; patients in whom coronary disease has been excluded; presence of severe refractory symptoms (NYHA class II-IV), as evidenced by moderate-to-severe functional disability resulting from exertional dyspnea or chest pain sufficient to support a desire for alternative treatment modalities, following administration (in standard dosages) of beta-blocker and either disopyramide or verapamil, independently or in association; peak instantaneous LV outflow tract gradient > 50 mm Hg (resting or provoked), estimated by continuous wave Doppler; Exclusion Criteria: end-stage phase of HCM (unless CRT therapy is considered); ejection fraction <50% (unless CRT therapy is considered); severe mitral valve disease (+++) not related to systolic anterior movement and/or papillary muscle abnormalities; age below 18 years.

Sites / Locations

  • Istituto Auxologico ItalianoRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

HCM patients with LVOT obstruction

Arm Description

Patients with obstructive HCM are considered for this study if 1) symptomatic, 2) refractory to optimized medical therapy and 3) not or poorly* eligible for septal myectomy or with an indication to implant a pacing device (pacemaker or ICD) independent on the ventricular obstruction.

Outcomes

Primary Outcome Measures

Reduction of LVOT pressure gradient
Long-term reduction in LVOT obstruction at rest and/or after Valsalva/Exercise > 30% in patients responding to acute stimulation test

Secondary Outcome Measures

Clinical improvement: change in NYHA class
Improvement of NYHA class
Clinical improvement: change in exercise capacity
6-minutes walking test
Clinical improvement: change in peak VO2
Improvement in peak VO2
Clinical improvement: change in NT-proBNP concentration
Reduction in NT-proBNP concentration

Full Information

First Posted
March 6, 2023
Last Updated
March 6, 2023
Sponsor
Istituto Auxologico Italiano
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1. Study Identification

Unique Protocol Identification Number
NCT05771987
Brief Title
Permanent Pacing for Drug-refractory Symptomatic Patients With Obstructive Hypertrophic Cardiomyopathy.
Acronym
PACE-OHCM
Official Title
Permanent Pacing as a Treatment for Drug-refractory Symptomatic Patients With Obstructive Hypertrophic Cardiomyopathy.
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Recruiting
Study Start Date
June 28, 2018 (Actual)
Primary Completion Date
June 2023 (Anticipated)
Study Completion Date
December 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Istituto Auxologico Italiano

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
The present trial is undertaken as a pilot study on selected patients, to evaluate the ability of acute hemodynamic testing to optimize pacing therapy and to predict the response of Obstructive Hypertrophic Cardiomyopathy (OHCM) to pacing, in terms of reduction of Left Ventricular Outflow Tract (LVOT) pressure gradient and functional capacity improvement. The Primary Objective is to demonstrate a long-term reduction in LVOT obstruction at rest and/or after Valsalva/Exercise > 30% in patients responding to acute stimulation test

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Obstructive Hypertrophic Cardiomyopathy

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
10 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
HCM patients with LVOT obstruction
Arm Type
Experimental
Arm Description
Patients with obstructive HCM are considered for this study if 1) symptomatic, 2) refractory to optimized medical therapy and 3) not or poorly* eligible for septal myectomy or with an indication to implant a pacing device (pacemaker or ICD) independent on the ventricular obstruction.
Intervention Type
Procedure
Intervention Name(s)
pace maker implant guided by acute hemodynamic testing
Intervention Description
To evaluate the ability of acute hemodynamic testing to optimize pacing therapy and to predict the response of HOCM to pacing
Primary Outcome Measure Information:
Title
Reduction of LVOT pressure gradient
Description
Long-term reduction in LVOT obstruction at rest and/or after Valsalva/Exercise > 30% in patients responding to acute stimulation test
Time Frame
3 months
Secondary Outcome Measure Information:
Title
Clinical improvement: change in NYHA class
Description
Improvement of NYHA class
Time Frame
6-12 months
Title
Clinical improvement: change in exercise capacity
Description
6-minutes walking test
Time Frame
6-12 months
Title
Clinical improvement: change in peak VO2
Description
Improvement in peak VO2
Time Frame
6-12 months
Title
Clinical improvement: change in NT-proBNP concentration
Description
Reduction in NT-proBNP concentration
Time Frame
6-12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: unequivocal diagnosis of HCM, on the basis of 2-dimensional echocardiographic demonstration of a hypertrophied (wall thickness >15 mm or > 13 mm in familial HOCM) and non dilated LV in the absence of another cardiac or systemic disease capable of producing the same magnitude of hypertrophy; patients in whom coronary disease has been excluded; presence of severe refractory symptoms (NYHA class II-IV), as evidenced by moderate-to-severe functional disability resulting from exertional dyspnea or chest pain sufficient to support a desire for alternative treatment modalities, following administration (in standard dosages) of beta-blocker and either disopyramide or verapamil, independently or in association; peak instantaneous LV outflow tract gradient > 50 mm Hg (resting or provoked), estimated by continuous wave Doppler; Exclusion Criteria: end-stage phase of HCM (unless CRT therapy is considered); ejection fraction <50% (unless CRT therapy is considered); severe mitral valve disease (+++) not related to systolic anterior movement and/or papillary muscle abnormalities; age below 18 years.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Valeria Rella
Phone
+393491482967
Email
v.rella@auxologico.it
Facility Information:
Facility Name
Istituto Auxologico Italiano
City
Milan
ZIP/Postal Code
20149
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Valeria Rella
Phone
+393491482967
Email
v.rella@auxologico.it

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Permanent Pacing for Drug-refractory Symptomatic Patients With Obstructive Hypertrophic Cardiomyopathy.

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