Prolonged Monitoring to Detect Ventricular Arrhythmias in Presymptomatic Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) Patients (PREPARE)
Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is an inherited condition characterized by life threatening heart racing, presenting with palpitations, cardiac arrest (collapse requiring an ambulance) or sudden death. The disease affects the right ventricle, the part of the heart that pumps blood to the lungs. ARVC is diagnosed with a wide range of tests that focus on the pumping function and the electrical signals from the right ventricle. These factors are summarized in a score that forms the ARVC Task Force Criteria. Genetic testing has identified 5 different genes that lead to ARVC, which are detected in about 60% of patients with ARVC. This allows doctors to test family members of the patient with ARVC to determine if they are at risk of developing the condition. Currently, family members undergo testing that includes imaging and electrical tests such as a 24-hour monitor to determine if they have evidence of ARVC. With increasing frequency, family members are found to have the gene that may lead to ARVC, but little or no evidence that their hearts are affected. This may be because the family member is too young to develop the condition, or that other factors that we do not understand have protected them from developing it.
The PREPARE study will study 100 patients that carry a gene that can lead to ARVC, but do not have anything more than minor evidence that the condition is present. These patients will not have heart racing on their initial 24-hour monitor. These patients will undergo long term monitoring with an implanted heart monitor that is inserted with a minor surgical procedure, which will detect abnormal heart rhythms that may provide a clue that heart racing from ARVC is present that is not detected with a 24-hour monitor that is performed on an annual basis (St. Jude Confirm implantable loop recorder). These patients will be enrolled in 10 adult and pediatric centers across Canada, and followed for 3 years after their heart monitor is implanted. If heart racing is detected, patients will discuss these results with their doctor to discuss what it means to them.
Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)
|Study Design:||Observational Model: Cohort
Time Perspective: Prospective
|Official Title:||Prolonged Monitoring to Detect Ventricular Arrhythmias in Presymptomatic ARVC Patients|
- Detection of ≥8 beats of wide QRS complex tachycardia considered ventricular tachycardia (HR>120 bpm*) by the ILR [ Time Frame: 3 year monitoring follow-up ]* an algorithm to determine the ventricular tachycardia detection rate
- Comparison of ventricular arrhythmia burden between routine [ Time Frame: 3 year monitoring follow-up ]* an algorithm to determine the ventricular tachycardia detection rate
- Change in 2010 Task Force Criteria Score from enrollment to 3-year follow-up. [ Time Frame: 3 year monitoring follow-up ]
- Detection of ≥30 seconds of wide QRS complex tachycardia considered ventricular tachycardia (HR>120 bpm*). [ Time Frame: 3 year monitoring follow-up ]
- Proportion of patients that go on to receive an ICD [ Time Frame: 3 year monitoring follow-up ]
- Proportion of patients that develop symptomatic sustained ventricular tachycardia [ Time Frame: 3 year monitoring follow-up ]
- Proportion of patients that develop sustained ventricular tachycardia, cardiac arrest or sudden death [ Time Frame: 3 year monitoring follow-up ]
|Study Start Date:||December 2010|
|Study Completion Date:||October 2013|
|Primary Completion Date:||October 2013 (Final data collection date for primary outcome measure)|
Presymptomatic ARVC gene carriers
ARVC gene positive patients without manifest ARVC after standard screening clinical testing.
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Please refer to this study by its ClinicalTrials.gov identifier: NCT01271816
|University of Western Ontario|
|London, Ontario, Canada, N6A 5A5|
|Principal Investigator:||Andrew Krahn, MD FRCPC||University of Western Ontario, Canada|