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Unpinning Termination Therapy for VT (US)

Primary Purpose

Ventricular Tachycardia

Status
Terminated
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Unpinning Termination therapy
Sponsored by
Cardialen, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional device feasibility trial for Ventricular Tachycardia focused on measuring Termination, Unpinning, Therapy

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

The subject must meet all of the following inclusion criteria:

  1. Life expectancy of 1 year or greater
  2. Male or female between 18 and 80 years of age
  3. Willing and able to comply with the study protocol, provide a written informed consent
  4. Indication for an endocardial VT catheter ablation for symptomatic VT with use of CESS V1.0 or CESS V1.1 OR an indication for an ICD procedure (de novo implant, replacement or upgrade) or de novo CRTD procedure for the risk of or presence of VT (CESS 1.0 and 1.1)
  5. Etiology of arrhythmia, or risk of arrhythmia being ischemic cardiomyopathy or non-ischemic cardiomyopathy
  6. Medically stable at time of consent to undergo DFT testing performed under general anesthesia or conscious sedation as determined by the investigator

Exclusion Criteria:

The subject must not meet any of the following exclusion criteria:

  1. Medically unstable at time of study and unsafe to undergo DFT testing under general anesthesia or conscious sedation as determined by the investigator
  2. Hemodynamic instability as determined by the investigator
  3. AF or atrial flutter at time of Study Procedure and no anticoagulation for preceding 3 weeks and no preoperative transesophageal echocardiographic, Cardiac CT or Intracardiac echocardiographic confirmation of the absence of LA thrombus
  4. Presence of intracardiac thrombus
  5. Inability to pass catheters to heart due to vascular limitations
  6. Cardiovascular anatomical defects that would complicate placement of the lead or catheter required by the protocol, including congenital heart disease and cardiac vein anomalies as determined by the investigator
  7. Pregnancy confirmed by test within 7 days of procedure
  8. Presence of a chronically implanted lead in the CS
  9. Presence of a ventricular assist device, including intra-aortic balloon pump
  10. Subjects indicated for VT ablation and experiencing VF
  11. Subjects requiring the use of inotropes and/or vasopressors for hemodynamic support within the 3 days prior to the study
  12. Prior VT catheter ablation with associated hemodynamic compromise despite pressor agents or stroke
  13. Incessant VT/VF or VT/VF storm within six months of scheduled procedure
  14. LVEF < 20%
  15. New York Heart Association (NYHA) Class IV heart failure
  16. Planned epicardial VT ablation on the same day as the research study
  17. History of hyper-coagulable state that could increase risk of thromboembolic events
  18. History of hemodynamic compromise due to valvular heart disease requiring IV inotropes or other circulatory support
  19. Unstable coronary artery disease as determined by the investigator
  20. Severe proximal three-vessel or left main coronary artery disease, without revascularization as determined by the investigators
  21. History of embolic stroke, Transient Ischemic Attack or other thromboembolic event in the past 6 months
  22. History of Hypertrophic Cardiomyopathy, Arrhythmogenic Right Ventricular Dysplasia, Congenital Heart Anomaly, Cardiac Amyloidosis, Genetic Cardiac Channelopathy or Cardiac Sarcoidosis
  23. Cardiovascular surgery or intervention within 1 month prior to enrollment or planned for up to 1 month after enrollment (other than the planned treatment procedure)
  24. Morbid obesity: BMI>39 kg/m2
  25. Cognitive or mental health status that would interfere with study participation and proper informed consent
  26. Presence of mechanical tricuspid valve
  27. Active Endocarditis
  28. Ventricular arrhythmia with etiology of sarcoid flare
  29. Previously implanted lead is under recall by manufacturer or evidence of lead failure as determined by the investigator
  30. End Stage Renal Disease on hemodialysis or peritoneal dialysis, or creatinine clearance <15 ml/min
  31. Any other medical condition which may affect the outcome of this study or safety of the subject as determined by the investigator

Sites / Locations

  • Mercy Medical Group
  • MercyOne Des Moines Medical Center
  • Minneapolis VA Healthcare System
  • Washington University
  • The Ohio State University Wexner Medical Center
  • OhioHealth Riverside Methodist Hospital
  • Baylor Scott & White Heart and Vascular Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

UPT Treatment

Arm Description

Investigational therapy (UPT)

Outcomes

Primary Outcome Measures

Arrhythmia Termination as assessed by the number of episodes restored to sinus rhythm
Assess the safety and performance of the Cardialen External Stimulation System and safety and performance ofUPT therapy

Secondary Outcome Measures

Full Information

First Posted
March 13, 2017
Last Updated
October 7, 2022
Sponsor
Cardialen, Inc.
Collaborators
National Heart, Lung, and Blood Institute (NHLBI), Washington University School of Medicine
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1. Study Identification

Unique Protocol Identification Number
NCT03093051
Brief Title
Unpinning Termination Therapy for VT (US)
Official Title
A Clinical Feasibility Study to Evaluate the Safety and Performance of Low-Energy Unpinning Termination Therapy in Patients With VT
Study Type
Interventional

2. Study Status

Record Verification Date
October 2022
Overall Recruitment Status
Terminated
Why Stopped
Sponsor ceased operations
Study Start Date
April 8, 2019 (Actual)
Primary Completion Date
October 1, 2022 (Actual)
Study Completion Date
October 1, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Cardialen, Inc.
Collaborators
National Heart, Lung, and Blood Institute (NHLBI), Washington University School of Medicine

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This observation study evaluates the safety and performance of UPT therapy in subjects during either an indicated ventricular tachycardia ablation procedure or an ICD implant procedure.
Detailed Description
This non-blinded, single-arm open-label, phase 1 pilot, acute research feasibility trial aims to demonstrate that the safety and effectiveness of Unpinning Termination (UPT) electrotherapy observed in the canine can be translated to humans and to demonstrate the safety and performance of UPT electrotherapy in the human population most likely to benefit from this therapy. This study evaluates the safety and performance of UPT therapy in subjects during either an indicated ventricular tachycardia (VT) catheter ablation or an indicated initial implant or device replacement of an implantable cardioverter defibrillator (ICD).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Ventricular Tachycardia
Keywords
Termination, Unpinning, Therapy

7. Study Design

Primary Purpose
Device Feasibility
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
Patients undergoing a routine clinically indicated procedure will have the investigational therapy delivered during the clinically indicated procedure.
Masking
None (Open Label)
Allocation
N/A
Enrollment
6 (Actual)

8. Arms, Groups, and Interventions

Arm Title
UPT Treatment
Arm Type
Experimental
Arm Description
Investigational therapy (UPT)
Intervention Type
Device
Intervention Name(s)
Unpinning Termination therapy
Other Intervention Name(s)
Multi-Stage Therapy, Multi-Stage Electrotherapy
Intervention Description
Electrotherapy comprised of standard biphasic and monophasic pacing pulses
Primary Outcome Measure Information:
Title
Arrhythmia Termination as assessed by the number of episodes restored to sinus rhythm
Description
Assess the safety and performance of the Cardialen External Stimulation System and safety and performance ofUPT therapy
Time Frame
During study procedure

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: The subject must meet all of the following inclusion criteria: Life expectancy of 1 year or greater Male or female between 18 and 80 years of age Willing and able to comply with the study protocol, provide a written informed consent Indication for an endocardial VT catheter ablation for symptomatic VT with use of CESS V1.0 or CESS V1.1 OR an indication for an ICD procedure (de novo implant, replacement or upgrade) or de novo CRTD procedure for the risk of or presence of VT (CESS 1.0 and 1.1) Etiology of arrhythmia, or risk of arrhythmia being ischemic cardiomyopathy or non-ischemic cardiomyopathy Medically stable at time of consent to undergo DFT testing performed under general anesthesia or conscious sedation as determined by the investigator Exclusion Criteria: The subject must not meet any of the following exclusion criteria: Medically unstable at time of study and unsafe to undergo DFT testing under general anesthesia or conscious sedation as determined by the investigator Hemodynamic instability as determined by the investigator AF or atrial flutter at time of Study Procedure and no anticoagulation for preceding 3 weeks and no preoperative transesophageal echocardiographic, Cardiac CT or Intracardiac echocardiographic confirmation of the absence of LA thrombus Presence of intracardiac thrombus Inability to pass catheters to heart due to vascular limitations Cardiovascular anatomical defects that would complicate placement of the lead or catheter required by the protocol, including congenital heart disease and cardiac vein anomalies as determined by the investigator Pregnancy confirmed by test within 7 days of procedure Presence of a chronically implanted lead in the CS Presence of a ventricular assist device, including intra-aortic balloon pump Subjects indicated for VT ablation and experiencing VF Subjects requiring the use of inotropes and/or vasopressors for hemodynamic support within the 3 days prior to the study Prior VT catheter ablation with associated hemodynamic compromise despite pressor agents or stroke Incessant VT/VF or VT/VF storm within six months of scheduled procedure LVEF < 20% New York Heart Association (NYHA) Class IV heart failure Planned epicardial VT ablation on the same day as the research study History of hyper-coagulable state that could increase risk of thromboembolic events History of hemodynamic compromise due to valvular heart disease requiring IV inotropes or other circulatory support Unstable coronary artery disease as determined by the investigator Severe proximal three-vessel or left main coronary artery disease, without revascularization as determined by the investigators History of embolic stroke, Transient Ischemic Attack or other thromboembolic event in the past 6 months History of Hypertrophic Cardiomyopathy, Arrhythmogenic Right Ventricular Dysplasia, Congenital Heart Anomaly, Cardiac Amyloidosis, Genetic Cardiac Channelopathy or Cardiac Sarcoidosis Cardiovascular surgery or intervention within 1 month prior to enrollment or planned for up to 1 month after enrollment (other than the planned treatment procedure) Morbid obesity: BMI>39 kg/m2 Cognitive or mental health status that would interfere with study participation and proper informed consent Presence of mechanical tricuspid valve Active Endocarditis Ventricular arrhythmia with etiology of sarcoid flare Previously implanted lead is under recall by manufacturer or evidence of lead failure as determined by the investigator End Stage Renal Disease on hemodialysis or peritoneal dialysis, or creatinine clearance <15 ml/min Any other medical condition which may affect the outcome of this study or safety of the subject as determined by the investigator
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Daniel H. Cooper, MD
Organizational Affiliation
Washington University School of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Mercy Medical Group
City
Sacramento
State/Province
California
ZIP/Postal Code
95819
Country
United States
Facility Name
MercyOne Des Moines Medical Center
City
Des Moines
State/Province
Iowa
ZIP/Postal Code
50314
Country
United States
Facility Name
Minneapolis VA Healthcare System
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55417
Country
United States
Facility Name
Washington University
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Facility Name
The Ohio State University Wexner Medical Center
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43210
Country
United States
Facility Name
OhioHealth Riverside Methodist Hospital
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43214
Country
United States
Facility Name
Baylor Scott & White Heart and Vascular Hospital
City
Dallas
State/Province
Texas
ZIP/Postal Code
75204
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
24076284
Citation
Janardhan AH, Gutbrod SR, Li W, Lang D, Schuessler RB, Efimov IR. Multistage electrotherapy delivered through chronically-implanted leads terminates atrial fibrillation with lower energy than a single biphasic shock. J Am Coll Cardiol. 2014 Jan 7-14;63(1):40-8. doi: 10.1016/j.jacc.2013.07.098. Epub 2013 Sep 26.
Results Reference
background
PubMed Identifier
23141483
Citation
Janardhan AH, Li W, Fedorov VV, Yeung M, Wallendorf MJ, Schuessler RB, Efimov IR. A novel low-energy electrotherapy that terminates ventricular tachycardia with lower energy than a biphasic shock when antitachycardia pacing fails. J Am Coll Cardiol. 2012 Dec 11;60(23):2393-8. doi: 10.1016/j.jacc.2012.08.1001. Epub 2012 Nov 7.
Results Reference
background
PubMed Identifier
21980076
Citation
Li W, Janardhan AH, Fedorov VV, Sha Q, Schuessler RB, Efimov IR. Low-energy multistage atrial defibrillation therapy terminates atrial fibrillation with less energy than a single shock. Circ Arrhythm Electrophysiol. 2011 Dec;4(6):917-25. doi: 10.1161/CIRCEP.111.965830. Epub 2011 Oct 6.
Results Reference
background
PubMed Identifier
16945810
Citation
Efimov I, Ripplinger CM. Virtual electrode hypothesis of defibrillation. Heart Rhythm. 2006 Sep;3(9):1100-2. doi: 10.1016/j.hrthm.2006.03.005. Epub 2006 Mar 10. No abstract available.
Results Reference
background
PubMed Identifier
16501014
Citation
Ripplinger CM, Krinsky VI, Nikolski VP, Efimov IR. Mechanisms of unpinning and termination of ventricular tachycardia. Am J Physiol Heart Circ Physiol. 2006 Jul;291(1):H184-92. doi: 10.1152/ajpheart.01300.2005. Epub 2006 Feb 24.
Results Reference
background
PubMed Identifier
19560090
Citation
Li W, Ripplinger CM, Lou Q, Efimov IR. Multiple monophasic shocks improve electrotherapy of ventricular tachycardia in a rabbit model of chronic infarction. Heart Rhythm. 2009 Jul;6(7):1020-7. doi: 10.1016/j.hrthm.2009.03.015. Epub 2009 Mar 11.
Results Reference
background
PubMed Identifier
20969974
Citation
Ambrosi CM, Ripplinger CM, Efimov IR, Fedorov VV. Termination of sustained atrial flutter and fibrillation using low-voltage multiple-shock therapy. Heart Rhythm. 2011 Jan;8(1):101-8. doi: 10.1016/j.hrthm.2010.10.018. Epub 2010 Oct 19.
Results Reference
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Unpinning Termination Therapy for VT (US)

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