Assessment of Combined CCM and ICD Device in HFrEF

Study Overview
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Brief Summary
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The goal of this clinical trial is to demonstrate that the OPTIMIZER® Integra CCM-D System (the CCM-D System) can safely and effective convert induced ventricular fibrillation (VF) and spontaneous ventricular tachycardia and/or ventricular fibrillation (VT/VF) episodes in subjects with Stage C or D heart failure who remain symptomatic despite being on guideline-directed medical therapy (GDMT), are not indicated for cardiac resynchronization therapy (CRT), and have heart failure with reduced left ventricular ejection fraction (LVEF ≤40%). Eligible subjects will be implanted with the CCM-D System. A subset of subjects will be induced into ventricular fibrillation on the table in the implant procedure room. During the follow-up period, inappropriate shock rate and device-related complications will be evaluated. The follow-up period is expected to last at least two years.

Official Title
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Assessment of the Safety and Efficacy of a Combined Cardiac Contractility Modulation and Implantable Cardioverter Defibrillator Device for Subjects With Heart Failure and Reduced Ejection Fraction

Conditions
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Heart Failure, Heart Failure With Reduced Ejection Fraction, Implantable Defibrillator User, CCM Therapy, Non-ischemic Cardiomyopathy, Ischemic Cardiomyopathy, Sudden Cardiac Arrest, Arrhythmias, Cardiac, Ventricular Tachycardia, Ventricular Fibrillation

Intervention / Treatment
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* Device: OPTIMIZER® Integra CCM-D System (Treatment Arm)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Individuals must meet all the following: Patient is aged 18 years or older; Patient meets the Stage C or D criteria of the Universal Definition of Heart Failure ; Patient has HFrEF (LVEF ≤40%); Patient is on GDMT for heart failure; Patient has a Class I or Class II indication for an ICD Patient has a reasonable expectation of meaningful survival of > 1 year; Patient has either non-ischemic cardiomyopathy or ischemic cardiomyopathy and is at least 40 days post-MI, if an MI occurred; Patient is willing to give informed consent, available for scheduled study follow-up visits, and able to complete all testing described in the study protocol at the investigational site location. Exclusion Criteria: An individual who meets any of the following criteria will be excluded from participation in this study: Patients should not have severe AI or AS, and should not have MS; additionally, patients undergoing DE testing should not have severe MR; Patients who have undergone mitral valve repair or clip within 90 days prior to study consent; Cardiac surgery within 90 days or a PCI procedure within 30 days prior to study consent; Prior heart transplant or ventricular assist device; Implanted mechanical tricuspid valve; PR interval greater than 375ms or advanced AV block; In situ S-ICD, pacemaker, or CRT device; Indicated for CRT; End stage renal disease, currently on dialysis, or with other major medical disorder (e.g. liver failure, terminal cancer); Indicated for permanent bradyarrhythmia pacing; Unstable angina pectoris within 30 days prior to study consent; Pregnant or planning to become pregnant during the study; Participating in another cardiac investigational device or drug study at the same time (or within 30 days prior to study consent); Note: Registries and other observational studies are acceptable. Other criteria that preclude Optimizer INTEGRA CCM-D implantation and/or CCM therapy, as determined by Investigator.

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
Intervention Model: Single Group Assignment
Interventional Model Description: Single arm, prospective, multicenter study of 300 subjects that will establish that the device can appropriately sense and convert episodes of induced VF on the table in the implant procedure room, spontaneous episodes of VT/VF that occur during the study follow-up period, and ensure that the inappropriate shock rate is not unacceptably high.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: CCM-D Implant<br>The subject is implanted with the CCM-D device. | Device: OPTIMIZER® Integra CCM-D System (Treatment Arm)<br>* The CCM-D System is an implantable cardiac device system that combines cardiac contractility modulation and implantable cardioverter defibrillator (ICD) modules into one device. CCM-D is also known as a Cardiac Contractility Modulation - Defibrillator. All 300 subjects will be implanted with the CCM-D System and followed for a period of at least two years.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Device Effectiveness in Converting Induced Ventricular Fibrillation (Primary Efficacy Objective) | Evaluate the device effectiveness in converting induced VF at the time of implantation. | Implant | 
| Device-related Complications (Primary Safety Objective) | Evaluate device-related complications through 6-months (excluding lead-related complications). | Implant to 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Inappropriate Shock Rate out to 6-months (Secondary Safety Objective) | Evaluate the incidence of inappropriate ICD shocks through the time when the last subject enrolled completes the 6-month visit. | Implant to 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Heart Failure, HFrEF, Stage C Heart Failure, Stage D Heart Failure, Defibrillation Efficacy Testing, Induced Ventricular Fibrillation, Ventricular fibrillation, Ventricular tachycardia, Implantable cardioverter defibrillator, Sudden cardiac arrest