A PRospective, rAndomizEd Comparison of subcuTaneOous and tRansvenous ImplANtable Cardioverter Defibrillator Therapy (PRAETORIAN)
|Ventricular Arrhythmias||Device: Implantation of subcutaneous ICD Device: Implantation of transvenous ICD|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
|Official Title:||Randomized Trial to Study the Efficacy and Adverse Effects of the Subcutaneous and Transvenous Implantable Cardioverter Defibrillator (ICD) in Patients With a Class I or IIa Indication for ICD Without an Indication for Pacing|
- Number of participants with implantable cardioverter defibrillator (ICD) related adverse events [ Time Frame: 48 months ]ICD related adverse events are defined as inappropriate shocks and/or implant-, lead- and device related complications. An inappropriate shock is shock therapy for anything else but ventricular fibrillation or ventricular tachycardia. Implant related complications are defined as ICD related infections, ICD related bleedings, thrombotic events, need for lead reposition, post-implant pneumothorax, post-implant hematothorax, or post-implant perforation/tamponade. Lead- or device related complications are all complications related to the lead or device.
- Number of Major Adverse Cardiac Event (MACE) [ Time Frame: 48 months ]MACE is defined as cardiac death, myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting and/or any valve surgery
- Number of appropriate shocks [ Time Frame: 48 months ]An appropriate shock is shock therapy for ventricular fibrillation or ventricular tachycardia.
- Number of inappropriate shocks [ Time Frame: 48 months ]Inappropriate shocks are defined as above.
- Number of complications individually [ Time Frame: 48 months ]Complications are defined as above.
- Quality of life [ Time Frame: 30 months ]The quality of life is measured by the SF-36 and Duke Activity Status Index questionnaires.
- Time to successful therapy [ Time Frame: 48 months ]Time to successful therapy is the time between the start of VT or VF until the first successful shock or first successful ATP episode. This includes the time of sensing and charging.
- First shock conversion efficacy [ Time Frame: 48 months ]First shock conversion efficacy is the amount of patients with VT or VF who are successfully converted with the first shock given by the transvenous ICD or subcutaneous ICD.
- Implant procedure time [ Time Frame: 48 months ]Implant procedure time is the time between the first incision and placement of the last suture (skin-to-skin time).
- Hospitalization rate [ Time Frame: 48 months ]The hospitalization rate is the number of days a patient is admitted to the hospital associated with ICD implantation.
- Fluoroscopy time [ Time Frame: 48 months ]Fluoroscopy time is the total time that fluoroscopy is used during the implantation of either the transvenous ICD or subcutaneous ICD.
- Cardiac (pre-)syncope events [ Time Frame: 48 months ]Cardiac syncope is a loss of consciousness due to cerebral hypoperfusion caused by cardiac arrhythmias or presumed cardiac arrhythmias
- Cross-overs to the other arm [ Time Frame: 48 months ]A crossover to the other arm is defined as a patient who for any reason after randomization is switched to the other ICD arm
- Cardiac decompensation [ Time Frame: 48 months ]Cardiac decompensation refers to acute failure of the heart to maintain adequate blood circulation for which hospitalization and medical treatment is necessary.
|Study Start Date:||February 2011|
|Estimated Study Completion Date:||December 2019|
|Estimated Primary Completion Date:||December 2019 (Final data collection date for primary outcome measure)|
Active Comparator: Subcutaneous ICD
Subcutaneous Implantable Cardioverter Defibrillator
Device: Implantation of subcutaneous ICD
Implantation of subcutaneous ICD
Active Comparator: Transvenous ICD
Transvenous Implantable Cardioverter Defibrillator
Device: Implantation of transvenous ICD
Implantation of transvenous ICD
Background of the study: The use of implantable cardioverter defibrillators (ICDs) is an established therapy for the prevention of death from ventricular arrhythmia. Recently a new subcutaneous ICD has been introduced, eliminating the need for transvenous lead placement in or on the heart which is mandatory in the transvenous ICD. The new subcutaneous ICD therapy already proved to be feasible and safe and is an approved therapy in Europe. It is likely that the eliminated need for transvenous lead placement substantially reduces the implantation related complications and elongates lead longevity and thus reduces inappropriate shocks associated with lead fractures. On the other hand it is unclear whether the lack of capability to provide antitachy-pacing (ATP) in the subcutaneous ICD may be a limitation for patients with frequent recurrent ventricular tachycardia. This randomized controlled trial will outline the advantages and disadvantages of the subcutaneous ICD.
Objectives of the study: (1) To compare the subcutaneous ICD to the transvenous ICD for major adverse events (i.e. inappropriate shocks, acute and chronic implant related complications and lead- or device related complications). (2) To determine to which degree the lack of ATP function leads to more appropriate shocks in patients with a subcutaneous ICD.
Study design: Multicenter, prospective, randomized controlled trial with either treatment with the transvenous ICD or subcutaneous ICD (1:1).
Study population: 2x425 patients with class I or IIa indication for ICD therapy without an indication for pacing.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01296022
Show 40 Study Locations
|Principal Investigator:||Reinoud E Knops, MD||Academic Medical Center - University of Amsterdam (AMC-UvA)|
|Study Chair:||Arthur A.M. Wilde, MD, PhD||Academic Medical Center - University of Amsterdam (AMC-UvA)|