Randomized Comparison of Endocardial Versus Epicardial - From the Coronary Sinus - Left Ventricular Pacing for Resynchronization in Heart Failure.
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 6
- 试验地点
- 2
- 主要终点
- the acute hemodynamic response judged by dP/dt max
研究概览
简要总结
Biventricular pacing is a validated treatment for patients suffering from heart failure resistant to medical treatment. However, up to 30% of the patients are non responsive to this strategy using the coronary sinus approach to pace the Left Ventricle (LV).
It has been demonstrated that the magnitude of the improvement was highly dependant on the LV pacing site. The coronary sinus approach rarely offers more than 1 or 2 potential pacing sites. Resynchronisation using a transeptal approach to pace the left ventricle on the cardiology has been shown feasible on small series. We therefore would like to compare these two approached in a randomised prospective study to confirm the hypotheses that endocardial LV pacing by offering multiple choices for the pacing sites reduces the number of non responders and is associated with greater hemodynamic benefit when compared to the conventional coronary sinus approach.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Adult (aged 18 or above)
- •Cardiac insufficiency of whatever cause (ischemic or non-ischemic)
- •Left ventricular ejection fraction <35%
- •NYHA Class III or IV with optimal medical treatment
- •QRS duration > 120 ms
- •Sinus rhythm
- •Patient must have signed informed consent
- •Patient must be registered in the national health care system
排除标准
- •Aged under 18
- •Patient with a mitral or aortic prosthesis
- •Patient with contraindication to anti-coagulants
- •Pregnant women
- •Participation in another study
- •Patient with contraindication for left ventricle catheterization by retrograde aortic approach , as a severe aortic stenosis requiring surgery, or an ascending aorta aneurism
研究组 & 干预措施
Epicardial
干预措施: Resynchronization using a coronary sinus approach (Device)
Endocardial
干预措施: Resynchronization using a transeptal approach (Device)
结局指标
主要结局
the acute hemodynamic response judged by dP/dt max
时间窗: Visit 3 : implantation day, during pacing procedure
The primary outcome will be the acute hemodynamic response of the randomized pacing modality (endocardial vs epicardial Left Ventricle pacing) as judged by the highest gain in dP/dt max
次要结局
- Pacing Procedure duration(Visit 3 : implantation day, end of pacing procedure)
- Clinical benefit at 6 month Follow up: quality of life questionnaire as compared to pre implantation(6-months after pacing procedure)
- Per and post implantation complications rate(Visit 4 : within 7 days after pacing procedure)
- Clinical benefit at 6 month Follow up: 6 minutes walk test(6-months after pacing procedure)
- pacing threshold performances of Left Ventricle pacing leads at 6 month Follow up(6-months after pacing procedure)
- number of left ventricular pacing sites assessed(Visit 3 : implantation day, end of pacing procedure)
- Post implantation echocardiography comparing spontaneous rhythm and biventricular pacing for left ventricle ejection fraction(within 7 days after pacing procedure)
- Post implantation echocardiography comparing spontaneous rhythm and biventricular pacing for mitral regurgitation(within 7 days after pacing procedure)
- Post implantation echocardiography comparing spontaneous rhythm and biventricular pacing for atrioventricular asynchronism(within 7 days after pacing procedure)
- Post implantation echocardiography comparing spontaneous rhythm and biventricular pacing for inter and intra-ventricular asynchronism(within 7 days after pacing procedure)
- sensing performances of left ventricle pacing leads(within 7 days after pacing procedure)
- pacing threshold performances of left ventricle pacing leads(within 7 days after pacing procedure)
- impedances performances of left ventricle pacing leads(within 7 days after pacing procedure)
- Complications rate at 6 month Follow up(Visit 6 : 6-months after pacing procedure)
- Clinical benefit at 6 month Follow up: Gain in NYHA(6-months after pacing procedure)
- Echocardiography at 6 month Follow up: as compared to pre implantation for Left Ventricle volumes(6-months after pacing procedure)
- Echocardiography at 6 month Follow up: as compared to pre implantation for mitral regurgitation(6-months after pacing procedure)
- impedances performances of Left Ventricle pacing leads at 6 month Follow up(6-months after pacing procedure)
- Implant success rate(Visit 3 : implantation day, end of pacing procedure)
- Echocardiography at 6 month Follow up: as compared to pre implantation for Left Ventricular Ejection Fraction(6-months after pacing procedure)
- Echocardiography at 6 month Follow up: as compared to pre implantation for inter and intra-ventricular asynchronism(6-months after pacing procedure)
- Echocardiography at 6 month Follow up: as compared to pre implantation for atrioventricular asynchronism(6-months after pacing procedure)
- sensing performances of Left Ventricle pacing leads at 6 month Follow up(6-months after pacing procedure)