[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"trial:NCT06332391":3,"trial-entities:NCT06332391":176,"trial-summary:NCT06332391":180},{"id":4,"nct_id":4,"org_study_id":5,"brief_title":6,"official_title":7,"overall_status":8,"completion_date":9,"status_verified_date":10,"last_update_date":11,"start_date":12,"sponsor_name":13,"lead_sponsor_class":14,"has_dmc":15,"brief_summary":16,"detailed_description":17,"conditions":18,"keywords":20,"study_type":31,"primary_purpose":32,"phases":33,"enrollment_info":35,"interventions":38,"primary_outcomes":48,"secondary_outcomes":53,"sex":111,"minimum_age":112,"maximum_age":113,"healthy_volunteers":114,"eligibility_criteria":115,"std_ages":144,"locations":147,"central_contacts":167,"overall_officials":171,"references":174,"see_also_links":175},"NCT06332391","202308349","Paced Heart Rate Acceleration for Cardiac Conditioning","A New Pacing Approach for Cardiac Conditioning and Enhanced Cardioprotection","RECRUITING","2028-11-30","2026-06","2026-06-25","2024-06-26","Denice Hodgson-Zingman, MD","OTHER",true,"A clinical trial of exercise-similar heart rate acceleration delivered via cardiac pacing vs. sham intervention in subjects at rest will be performed. The study population comprises subjects with guideline-directed medically managed left ventricular dysfunction due to ischemic or non-ischemic cardiomyopathy and an existing implantable cardioverter defibrillator or biventricular implantable cardioverter defibrillator. The purpose of the study is to understand how the heart rate pattern of exercise contributes to the considerable cardiac conditioning effects of exercise and estimate whether the pacing approach may have translational clinical applicability. Fifty-two subjects will be randomized, single-blinded, to either the pacing intervention or a sham intervention which they will receive once daily, 3 days\u002Fweek for 6 weeks. Baseline symptoms and clinical test results will be compared to the same measures at 2 weeks, 4 weeks and 6 weeks of intervention\u002Fsham and at 3 months and one-year post-intervention. The primary endpoint will be the change in left ventricular ejection fraction from baseline in intervention vs. sham groups (mixed effects linear regression with time and treatment arm as fixed effects and pre-specified covariates of sex and cardiomyopathy type as random effects). Secondary endpoints will include changes in quality of life, 6-minute walk distance, cardiopulmonary exercise test (CPET) measures, daily activity and major adverse cardiac events (MACE) at 3 and 12 months between pacing and sham groups. A \"dose-response\" analysis of outcomes at 2, 4, and 6 weeks of the intervention vs. sham compared with baseline will be performed.","Subjects and protocol: This is a phase II randomized, controlled, prospective clinical trial in subjects with systolic heart failure. It is designed to assess the effect on symptoms, functional, structural, and medical outcomes in response to an atrial paced reproduction of the heart rate exercise pattern delivered regularly over a 6-week period. A single center (University of Iowa) will execute the intervention\u002Fsham and subject testing. A separate center (Cleveland Clinic) will perform statistical analysis of deidentified data. Fifty-two subjects will be randomized 1:1 by computer generated code to either the intervention (pacing) arm or the sham arm. The subject, but not researcher, will be blinded to randomization status (single-blind). Analysis of data will be performed in a blinded fashion. Within 2 weeks prior to initiation of pacing vs. sham interventions, baseline testing will be performed including collection and storage of plasma, testing for blood urea nitrogen (BUN), creatinine, N-terminal pro-b-type natriuretic peptide (NT-proBNP), echocardiographic left ventricular (LV) dimensions, left ventricular ejection fraction (LVEF), and quality of life\u002Fsymptoms by both the Minnesota Living with Heart Failure (MLHF) and the Kansas City Cardiomyopathy Questionnaire (KCCQ), designed for assessment of symptoms over 1 month and 2 week windows, respectively, distance on 6-minute walk, 1 week of pacing device accelerometer-derived activity measures, wearable activity monitor measures, and cardiopulmonary exercise test (CPET) for determination of metabolic equivalents (METs), maximum oxygen consumption (VO2max) and anaerobic threshold (AT) estimated noninvasively, using the rapid incremental exercise test. In addition, starting 1 week prior and continuing through 1 month after the pacing vs. sham intervention, each subject will be provided a wearable activity monitor and their daily activity analyzed as a cofactor. At the end of 2, 4 and 6 weeks of pacing\u002Fsham, as well as 3 and 12 months after the intervention, the same outcome measures as at baseline will be collected as well as major adverse cardiovascular events (MACE), weight, medications, and arrhythmias recorded on the subject's implantable cardioverter defibrillator (ICD) or biventricular ICD (BiV\u002FICD). At the end of the pace\u002Fsham period, subject blinding will be assessed by asking subjects if they believe they were in pace or sham group. Collected plasma will be saved for metabolomic testing in year 5 to correlate with findings in mouse models. Outcomes: All tests result analyses will be done by 2 independent clinicians, qualified in specific areas, blinded to the randomization. A reviewer who analyzes a testing parameter will analyze the same parameter for all subjects. Variability between reviewers will be analyzed. The primary endpoint will be change in left ventricular ejection fraction (LVEF) from baseline. Secondary endpoints will include quality of life (QOL) by MLHF score, 6-min walk distance, CPET (including VO2max, metabolic equivalents (METs) achieved, peak power output, total exercise time), daily activity change from baseline and MACE at 3 and 12 months between pacing and sham groups. A \"dose-response\" analysis of outcomes at 2, 4, and 6 weeks of the intervention vs. sham compared with baseline will be performed. Durability analysis of response at 3 and 12 months will be performed.\n\nThe data from all subjects completing at least one pacing vs. sham session will undergo analysis for measures of tolerability (symptoms, maximum achieved pacing rate, appearance of arrhythmias, changes in vital signs and bioimpedance cardiac output) with respect to age, sex, degree, type of cardiomyopathy (ischemic vs. non-ischemic), left ventricular function, NT-proBNP, NHYA class, baseline oxygen consumption (VO2), baseline exertional tolerance, baseline physical activity level as assessed by the ICD of BiV\u002FICD accelerometer and wearable activity watch, autonomic function as defined by heart rate variability derived from electrocardiogram (ECG) and stored ICD or BiV\u002FICD data. Hospitalizations, deaths, or other adverse outcomes will similarly be analyzed with respect to baseline data and procedural data such as maximum achieved pacing rate.\n\nFor those subjects completing the intervention\u002Fsham and follow up visits, the primary endpoint of change in left ventricular ejection fraction will be analyzed. Secondary endpoints will include changes in functional capacity, particularly 6-minute walk, and quality of life indicators as well as MACE with respect to the above study variables.\n\nDescriptive statistics will be used to summarize participant demographic and clinical characteristics at baseline. Categorical variables will be compared using Chi squared tests. For continuous variables, to relax the strict requirement of normality, non-parametric methods for unadjusted comparison will be used (Wilcoxon rank-sum test, also known as the Mann-Whitney two-sample statistic, for comparison of two independent samples. Wilcoxon matched pairs signed-rank test will be used for paired comparisons). For the primary endpoint analysis, a mixed-effects linear regression model will be used to compare the two study arms on the primary outcome of LVEF, with time (2, 4, and 6 wks) and treatment arm (intervention vs. sham) included as fixed effects, and pre-specified covariates of sex (binary male\u002Ffemale) and cardiomyopathy type (binary ischemic\u002Fnon-ischemic) as random effects. Both stratified randomization by sex and cardiomyopathy type, as well as adjustment for these covariates in the analysis, will be performed. Although often only one or the other technique is sufficient, both are performed here given the well-known confounding effects of sex and cardiomyopathy types in heart failure trials and a desire to be highly rigorous in this regard. An intercept for time of treatment or sham (2, 4, 6 wks) will be included. The significance criteria for the model coefficient corresponding to treatment will be .025 with a one-sided 97.5% confidence interval. Analyses will be conducted on an \"intention-to-treat\" basis. Estimates and confidence intervals of effect sizes and standard deviation of outcome measures will be presented. Pre-specified subgroup analyses will probe for treatment effect heterogeneity in outcomes based on sex and ischemic cardiomyopathy vs. nonischemic cardiomyopathy. Secondary endpoints will be analyzed in a fashion similar to the primary endpoint analysis. Due to the controlled environment, missing data are expected to be very rare. If such exists, patterns will be evaluated, and multiple imputation performed.",[19],"Heart Failure, Systolic",[21,22,23,24,25,26,27,28,29,30],"heart failure","exercise","heart rate","implantable defibrillator","cardiac conditioning","exercise tolerance","pacing","cardiac output","quality of life","walking distance","INTERVENTIONAL","TREATMENT",[34],"NA",{"count":36,"type":37},52,"ESTIMATED",[39,44],{"type":40,"name":41,"description":42,"armGroupLabels":43},"DEVICE","Exercise-similar cardiac pacing","Cardiac pacing using subjects already-implanted cardioverter defibrillator to reproduced exercise heart rate envelope.",[41],{"type":40,"name":45,"description":46,"armGroupLabels":47},"Sham cardiac pacing","Simulated (rates selected using programmer but not initiated) cardiac pacing using subjects already-implanted cardioverter defibrillator to reproduced exercise heart rate envelope.",[45],[49],{"measure":50,"description":51,"timeFrame":52},"Change in left ventricular ejection fraction by echocardiogram","The change in left ventricular ejection fraction from baseline as determined by echocardiography","at baseline versus 2 weeks, 4 weeks, 6 weeks from start of intervention\u002Fsham and at 3 months and 12 months after completion of intervention vs. sham.",[54,57,59,62,65,68,71,74,77,80,83,86,89,93,96,99,102,105,108],{"measure":55,"description":56,"timeFrame":52},"Quality of Life score on the Minnesota Living with Heart Failure questionnaire","Numerical score based on a subject's subjective symptoms and functional status",{"measure":58,"description":56,"timeFrame":52},"Quality of Life score on the Kansas City Cardiomyopathy Questionnaire",{"measure":60,"description":61,"timeFrame":52},"6-minute walk distance","Distance on a standard 6-minute walk measured in meters",{"measure":63,"description":64,"timeFrame":52},"Cardiopulmonary exercise test maximum oxygen consumption","V02max (maximum milliliters of oxygen consumed per kilogram of body weight per minute)",{"measure":66,"description":67,"timeFrame":52},"Cardiopulmonary exercise test metabolic equivalents achieved","metabolic equivalents (METs)",{"measure":69,"description":70,"timeFrame":52},"Cardiopulmonary exercise test peak power output achieved","peak power output (watts\u002Fkilogram)",{"measure":72,"description":73,"timeFrame":52},"Cardiopulmonary exercise test total exercise time","total exercise time (minutes)",{"measure":75,"description":76,"timeFrame":52},"daily minutes of sedentary activity","CamNtech motion watch 8 average daily minutes of activity in the sedentary range",{"measure":78,"description":79,"timeFrame":52},"daily minutes of low activity","CamNtech motion watch 8 average daily minutes of activity in the low range",{"measure":81,"description":82,"timeFrame":52},"daily minutes of moderate activity","CamNtech motion watch 8 average daily minutes of activity in the moderate range",{"measure":84,"description":85,"timeFrame":52},"daily minutes of vigorous activity","CamNtech motion watch 8 average daily minutes of activity in the vigours range",{"measure":87,"description":88,"timeFrame":52},"major adverse cardiac events","MACE",{"measure":90,"description":91,"timeFrame":92},"symptom score during the intervention\u002Fsham procedure","An aggregate score of a subject's subjective report of shortness of breath, chest pain, palpitations, lightheadedness, each on a scale of 0-10. Minimum score 0, maximum score 40.","at each intervention\u002Fsham procedure - these occur 3 days per week for 6 weeks at the beginning of the study",{"measure":94,"description":95,"timeFrame":92},"maximum achieved pacing rate during the intervention\u002Fsham procedure","measured in beats\u002Fminute",{"measure":97,"description":98,"timeFrame":92},"presence of significant arrhythmia during the intervention\u002Fsham procedure","binary outcome of 0 (no such arrhythmia) versus 1 (presence of a significant arrhythmia) during each episode of pacing. A significant arrhythmia refers to either subject-reported symptoms during the arrhythmia, or a change in systolic blood pressure of 20 mmHg from that immediately before the onset of the arrhythmia, or an arrhythmia requiring intervention to terminate.",{"measure":100,"description":101,"timeFrame":92},"vital signs - systolic blood pressure during the intervention\u002Fsham procedure","maximum change in systolic blood pressure (millimeters of mercury) during the intervention\u002Fsham period versus the baseline blood pressure immediately before initiation of intervention\u002Fsham procedure as measured by plethysmography (standard inflatable blood pressure cuff).",{"measure":103,"description":104,"timeFrame":92},"vital signs - oxygen saturation in the blood during the intervention\u002Fsham procedure","maximum change in blood oxygen saturation (measured as % saturation) during the intervention\u002Fsham period versus the baseline immediately before initiation of intervention\u002Fsham procedure as measured by pulse oximeter.",{"measure":106,"description":107,"timeFrame":92},"tolerability - vital signs - cardiac output","maximum change in cardiac output during the intervention\u002Fsham period versus the baseline immediately before initiation of intervention\u002Fsham procedure as measured by NICaS bioimpedance device.",{"measure":109,"description":110,"timeFrame":92},"vital signs - cardiac output during the intervention\u002Fsham procedure","maximum change in cardiac output (liters\u002Fminute) during the intervention\u002Fsham period versus the baseline immediately before initiation of intervention\u002Fsham procedure as measured by NICaS bioimpedance device.","ALL","18 Years","120 Years",false,{"inclusion":116,"exclusion":126,"raw_text":143},[117,118,119,120,121,122,123,124,125],"Provision of signed and dated informed consent form","Stated willingness to comply with all study procedures and availability for the duration of the study","Male or female sex","Age 18 years or greater","Available transportation for study visits","Left ventricular ejection fraction \\\u003C or = 40% despite at least 3 months guideline-directed medial therapy","NYHA class II-III heart failure symptoms","Atrial-lead inclusive implantable cardioverter defibrillator or biventricular defibrillator in place \\> 3 months","Intrinsic or biventricular paced QRS duration of \\\u003C= 120 milliseconds",[127,128,129,130,131,132,133,134,135,136,137,138,139,140,141,142],"Age \\\u003C 18 years","Inability to ambulate safely","Congenital or primary valve disease","Ongoing (not suppressed) atrial arrhythmias","Left ventricular thrombus","Severe peripheral arterial disease that limits mobility","Hospital admission for life-threatening condition (e.g. heart failure, stroke) in the past 3 months","Major surgery in the past 3 months or anticipated during the period of study","Ventricular pacing indication in the absence of biventricular pacing","Life expectancy \\\u003C 1 year","Hemodialysis","Hematocrit \\\u003C 30%","Severe chronic lung disease that limits activity or requires oxygen","Pregnancy","Implantable cardioverter defibrillator battery longevity \\\u003C 1 year","Vulnerable populations such as prisoners and institutionalized individuals","Inclusion Criteria:\n\n* Provision of signed and dated informed consent form\n* Stated willingness to comply with all study procedures and availability for the duration of the study\n* Male or female sex\n* Age 18 years or greater\n* Available transportation for study visits\n* Left ventricular ejection fraction \\\u003C or = 40% despite at least 3 months guideline-directed medial therapy\n* NYHA class II-III heart failure symptoms\n* Atrial-lead inclusive implantable cardioverter defibrillator or biventricular defibrillator in place \\> 3 months\n* Intrinsic or biventricular paced QRS duration of \\\u003C= 120 milliseconds\n\nExclusion Criteria:\n\n* Age \\\u003C 18 years\n* Inability to ambulate safely\n* Congenital or primary valve disease\n* Ongoing (not suppressed) atrial arrhythmias\n* Left ventricular thrombus\n* Severe peripheral arterial disease that limits mobility\n* Hospital admission for life-threatening condition (e.g. heart failure, stroke) in the past 3 months\n* Major surgery in the past 3 months or anticipated during the period of study\n* Ventricular pacing indication in the absence of biventricular pacing\n* Life expectancy \\\u003C 1 year\n* Hemodialysis\n* Hematocrit \\\u003C 30%\n* Severe chronic lung disease that limits activity or requires oxygen\n* Pregnancy\n* Implantable cardioverter defibrillator battery longevity \\\u003C 1 year\n* Vulnerable populations such as prisoners and institutionalized individuals",[145,146],"ADULT","OLDER_ADULT",[148],{"facility":149,"status":8,"city":150,"state":151,"zip":152,"country":153,"contacts":154,"geoPoint":164},"University of Iowa Hospitals and Clinics","Iowa City","Iowa","52242","United States",[155,158,162],{"name":13,"role":156,"phone":157},"CONTACT","319-356-1616",{"name":159,"role":156,"phone":160,"email":161},"Melissa Yoder, RN","319-384-1628","melissa-yoder@uiowa.edu",{"name":13,"role":163},"PRINCIPAL_INVESTIGATOR",{"lat":165,"lon":166},41.66113,-91.53017,[168],{"name":13,"role":156,"phone":169,"email":170},"+1 319 384 2915","denice-zingman@uiowa.edu",[172],{"name":13,"affiliation":173,"role":163},"University of Iowa",[],[],{"nct_id":4,"conditions":177,"biomarkers":179},[178],"Heart Failure",[],{"nct_id":4,"found":15,"summary":181,"prompt_version":191},{"design":182,"status":183,"heading":184,"summary":185,"follow_up":186,"word_count":187,"commitments":188,"compensation":189,"drugs_mentioned":190},"This is a randomized, controlled study with 52 participants, where you would be assigned by computer to either the pacing or sham group. You would not know which group you are in, but the researchers would.","completed","Paced Heart Rate Acceleration for Heart Failure","This study is testing a new approach called \"Exercise-similar cardiac pacing\" for people with systolic heart failure. This involves using your existing implanted cardioverter defibrillator (a device that helps regulate your heartbeat) to mimic the heart rate changes that happen during exercise. The study compares this pacing to a \"Sham cardiac pacing\" where the device settings are changed but no actual pacing happens. To join, you need to be 18 or older, have heart failure with a left ventricular ejection fraction (a measure of how well your heart pumps blood) of 40% or less, and be in NYHA class II-III (meaning you have some limitations due to heart failure symptoms). The main goal is to see if this pacing can improve your heart's pumping ability (left ventricular ejection fraction) over time. The study is currently unclear on its recruitment status.","You would be followed for 12 months after the 6-week intervention period ends.",140,"You would undergo baseline testing, then receive either pacing or sham intervention regularly over a 6-week period. You would have follow-up tests at 2, 4, and 6 weeks during the intervention, and then at 3 and 12 months after it finishes.","Not stated in the trial record.",[41,45],"v2"]