Avoid DeliVering TherApies for Non-sustained Arrhythmias in ICD PatiEnts III

Study Overview
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Brief Summary
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To demonstrate a reduction in the number of ventricular therapies (ATP and Shocks) delivered for treating spontaneous arrhythmia episodes with a fast cycle length (CL≤ 320ms) as a consequence of self-termination and better arrhythmia discrimination due to a greater number of R-R intervals necessary to detect ventricular events.

Detailed Description
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Primary Objective: The primary objective is to demonstrate a 20% reduction of ventricular therapies (ATP and Shocks) delivered for treating spontaneous arrhythmia episodes with a fast cycle length (CL ≤ 320 ms) by choosing a number of 30 out of 40 intervals to detect (NID) compared to a NID of 18 out of 24 in subjects with either Class I or IIA indication for ICD implantation, regardless of cardiac resynchronization capabilities. Secondary Objectives: Evaluate the percent reduction in the number of shocks delivered per subject for treating spontaneous episodes with a fast cycle length (CL ≤ 320 ms) and for spontaneous ventricular episodes. Evaluate the efficacy of ATP in successfully treating spontaneous ventricular episodes (CL: 200ms-320ms) for subjects in primary and secondary prevention in both arms of the study. Evaluate acceleration rate or degeneration into VF of spontaneous episodes (CL of 200ms-320ms) due to ATP therapy in the two study arms. Compare the likelihood of syncopal events associated with spontaneous episodes with a fast cycle length (CL ≤ 320 ms). Describe the economic impact and the quality of life consequences.

Official Title
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ADVANCE III: Avoid DeliVering TherApies for Non-sustained Arrhythmias in ICD PatiEnts III

Conditions
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Heart Disease

Intervention / Treatment
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* Device: Implantable Defibrillator
* Device: Implantable Defibrillator


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Either ICD or CRT+ICD indications (Class I-IIA) according to the current AHA / ACC / ESC guidelines. Previous implant of a Medtronic device including ATP During Charging feature for 15 days at the maximum. Exclusion Criteria: ICD replacements and upgrading. Brugada Syndrome, Long QT and HCM patients Ventricular tachyarrhythmia associated with reversible cause. Other electrical implantable devices (Neurostimulators, etc.). Subject's life expectancy less than 1 year. Subject on heart transplant list which is expected in less than 1 year. Subject is <18 years of age, or the subject is under a minimum age that is required as defined by local law Women who are pregnant or women of childbearing potential who are not on a reliable form of birth control. Unwillingness or inability to provide written informed consent. Enrolment in, or intention to participate in, another clinical trial. Inaccessibility to come to the study center for the follow-up visits. Mechanical tricuspid valve.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Long NID<br>Programming a number of 30 out of 40 intervals to detect (NID)ventricular arrhythmia | Device: Implantable Defibrillator<br>* Number of 30 out of 40 intervals to detect (NID)Fast Ventricular Tachycardia<br>|
| Active Comparator: Short NID<br>Programming a number of 18 out of 24 intervals to detect (NID)ventricular arrhythmia | Device: Implantable Defibrillator<br>* number of 18 out of 24 intervals to detect (NID)Fast Ventricular Tachycardia<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| For the Primary Endpoint the Reduction of Ventricular Therapies (ATP and Shocks) Delivered for Treating Fast Spontaneous Arrhythmia Episodes Was Measured. | for each patient, the exposure time was calculated as the period between randomization and until study completion or exit whichever occured first. Exposure times for all patients were then summed. The rate of therapies was calculated as the sum of all therapies delivered in the study (for each arm) over the sum of exposure times * 100. | From enrollment to study completion or exit whichever occured first | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Evaluate the Percent Reduction in the Number of Shocks Delivered Per Subject for Treating Spontaneous Episodes With a Fast Cycle Length (CL < 320 ms) and for Spontaneous Ventricular Episodes. |  | end of study | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Shocks, Implantable Cardiac Defibrillator, therapies reduction, Quality of Life