Spinal Cord Stimulation in Hypotensive Heart Failure Patients: Hemodynamic Assessment

Federal State Budgetary Institution, V. A. Almazov Federal North-West Medical Research Centre, of the Ministry of Health

Status: Terminated

Conditions: Heart Failure

Treatments: Procedure: Spinal cord stimulation

Study type: Interventional

Funder types: Other

Identifiers

NCT05288387

HF-SCS-2022

Details and patient eligibility

About

This is a prospective single-center study that aims to evaluate the effects of non-invasive transcutaneous spinal cord stimulation on systemic and pulmonary hemodynamics, assessed during right heart catheterization in patients with heart failure and persistent or transient hypotension subjected to be included into the heart transplantation waiting list.

Full description

The study aims to assess hemodynamic effects of non-invasive transcutaneous spinal cord stimulation during invasive hemodynamics evaluation in patients with heart failure and transient or persistent hypotension undergoing catheterization before inclusion into the heart transplantation program. Eligible patients will sign an informed consent form before the procedure. Non-invasive transcutaneous electrical stimulation of the spinal cord will be applied using high-frequency modulated electrical impulses through adhesive electrodes attached to the back skin. The stimulation protocol includes analysis of the following parameters: heart rate; electrocardiogram in 12 leads; invasive blood pressure; pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac input, cardiac index, stroke volume, stroke volume index, systemic vascular resistance, pulmonary vascular resistance.

Enrollment: 6 patients

Sex: All

Ages: 18 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Age 18-75 years.
2. Patients with heart failure III-IV functional class (NYHA) with indications to right heart catheterization.
3. Systolic blood pressure <110/70 mm Hg when measured while sitting.
4. Patient who signed an informed consent form.

Exclusion criteria

1. Hypovolemic status (central venous pressure <2 mm Hg).
2. Any acute illness.
3. Transient ischemic event or stroke within 2 weeks prior to inclusion.
4. Pulmonary embolism <1 month ago.
5. Epilepsy.
6. An implanted infusion pump.
7. Pacemaker-dependent patients.
8. Patients who have contraindications to the use of the patch electrodes used in this study, as indicated in the respective instructions for use.

Trial design

Primary purpose: Supportive Care

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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6 participants in 1 patient group

Spinal cord stimulation in heart failure patients with hypotension

Experimental group

Description:

Adhesive patches are applied to subjects' back skin. Single stimuli are delivered in order to define the stimulation threshold under the guidance of neuromyography. Vascular access is performed (jugular or subclavian) according to conventional preparation to right heart catheterization. Invasive hemodynamic measures are performed as usual. High-frequency spinal cord stimulation at T5 level is initiated, and repeated hemodynamic measures performed within 2 minutes. Stimulation lasts for 5-10 minutes, and then ceased. Following a 5-minutes waiting period, repeat hemodynamic measures are performed. The same sequence of steps applies for stimulation levels T7-8 and a combination of T5 and T7-8. Then the procedure is completed and data are analysed.

Treatment:

Procedure: Spinal cord stimulation