A Randomised Trial of S-ICD Implantation With and Without Defibrillation Testing (PRAETORIAN-DFT)
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|ClinicalTrials.gov Identifier: NCT03495297|
Recruitment Status : Recruiting
First Posted : April 12, 2018
Last Update Posted : August 10, 2020
|Condition or disease||Intervention/treatment||Phase|
|Ventricular Arrythmia||Procedure: ommitence of defibrillation testing||Not Applicable|
Implantable Cardioverter Defibrillator (ICD) implant improves survival in patients with a higher risk for sudden cardiac death. There are 2 types of ICD available; transvenous ICD (TV-ICD) and subcutaneous ICD (S-ICD). During ICD implant, defibrillation testing (DFT) is performed to test functionality of the device. However, DFT can be associated with complications such as inability to convert, complications arising from general anaesthesia, prolonged resuscitation, stroke and death. Whereas DFT may be associated with complications, the benefit of DFT is debated as literature shows there is only a modest average effect of DFT, if any, on mortality, shock efficacy or safety. Recently it was shown in a randomized controlled trial called 'SIMPLE' that routine defibrillation testing of TV-ICDs at the time of implant does not improve shock efficacy or reduce arrhythmic death. For S-ICD there is only limited data available of the effect of DFT on S-ICD efficacy. Data have however shown that the conversion efficacy of the S-ICD is comparable to TV-ICD.
DFT is currently performed in standard S-ICD implants, but is omitted in specific cases. However, an alternative method to evaluate the correct position may be desired when omitting DFT. The PRAETORIAN Score is developed using computer modelling data on factors influencing defibrillation thresholds. The PRAETORIAN score represents the chance of a patient having an elevated defibrillation threshold and consequently failing a DFT or conversion of a spontaneous arrhythmia episode. The score was retrospectively validated in two studies with 180 and 321 patients.
It was reported that most S-ICD implants are performed under general anesthesia, however other anesthesia protocols are used as well. One of the most predominant factors to use general anesthesia is the performance of the DFT. If this is omitted, other anesthesia protocols may be a good option for many patients as well.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||965 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||None (Open Label)|
|Primary Purpose:||Supportive Care|
|Official Title:||A Prospective Randomised CompArative Trial of SubcutanEous ImplanTable CardiOverter-DefibrillatoR ImplANtation With and Without DeFibrillation Testing|
|Actual Study Start Date :||May 7, 2018|
|Estimated Primary Completion Date :||September 2023|
|Estimated Study Completion Date :||September 2023|
No Intervention: S-ICD Implant with defibrillation test
Patients undergoing de novo S-ICD implantation including induction of VF and defibrillation testing post-implant
Experimental: S-ICD Implant without defibrillation test
Patients undergoing de novo S-ICD implantation without induction of VF and defibrillation testing post-implant
Procedure: ommitence of defibrillation testing
Induction of a ventricular arrhythmia to test proper arrhythmia detection and termination by the implanted device is omitted
- Failed first appropriate shock in a spontaneous episode [ Time Frame: 40 months ]Number of patients having experiences a failed first appropriate shock in a spontaneous arrhythmia episode
- DFT related complications [ Time Frame: 24 hours or 30 days ]Number of patients experiencing DFT related complications occurring within 24h or 30 days after DFT
- PRAETORIAN Score [ Time Frame: up to 24 hours ]Implant position will be scored using the PRAETORIAN score
- Pain post implant [ Time Frame: 1-4 hours post implant ]Pain score measured with McGill questionnaire
- Appropriate ICD therapy [ Time Frame: 40 months ]Shocks given for VT or VF
- Inappropriate ICD therapy [ Time Frame: 40 months ]Shocks given for anything else than VT or VF
- Overall DFT conversion success [ Time Frame: 40 months ]The percentage of patients with at least one induced episode teminated by an S-ICD shock within five seconds post shock delivery
- Successful DFT [ Time Frame: 40 months ]A successful DFT is defined as conversion to SR or AF in less than 5 seconds from appropriate shock delivery.
- Time to therapy [ Time Frame: 40 months ]Time to therapy is the time between the start of VT or VF in a treated episode until the first shock in seconds.
- Time to succesful therapy [ Time Frame: 40 months ]Time to successful therapy is the time between the start of VT or VF until the first successful shock.
- Shock efficacy [ Time Frame: 40 months ]Percentage of appropriate shocks that was successfull
- Conversion efficacy within 5 shocks in spontaneous episodes [ Time Frame: 40 months ]Conversion efficacy within 5 shocks in spontaneous episodes
- S-ICD related complications [ Time Frame: 40 months ]S-ICD related complications requiring invasive intervention
- MACE post DFT [ Time Frame: 30 days ]Number of Major Adverse Cardiac Events after DFT procedure
- Cardiac (pre-)syncope [ Time Frame: 40 months ]Number of episodes of cardiac (pre-)syncope
- Cardiac decompensation [ Time Frame: 40 months ]Number of episodes of cardiac decompensation
- Mortality [ Time Frame: 40 months ]All cause mortality; arrhythmic death; cardiovascular death; unexplained death
- Length of hospitalization [ Time Frame: 40 months ]Length of hospitalization post implant (nights)
- Device or lead repositioning [ Time Frame: 40 months ]Number of procedures for device or lead repositioning
- ICD related infection [ Time Frame: 40 months ]Number of infections related to implanted ICD
- Composite complications 30 days after implant [ Time Frame: 30 days ]Number of patients experiencing complications occurring within 30 days after implant
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03495297
|Contact: Reinoud E Knops, MD, PhDemail@example.com|
|Contact: Lonneke Schats - Smeding, PhDfirstname.lastname@example.org|
|Principal Investigator:||Reinoud E Knops, MD, PhD||Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)|