Impact of Pacing Mode and Diastolic Function on Cardiac Output

Not Applicable

Completed

• Conditions: AV Block; Cardiac Output; Diastolic Function; Pacemaker Stimulation Mode; Stroke Volume
• Interventions: Other: Pacemaker stimulation mode

• Registration Number: NCT04068233
• Lead Sponsor: Kepler University Hospital

Brief Summary

Background It is known from previous research that in patients with complete AV (atrioventricular) block and pacemaker stimulation stroke volume and cardiac output are higher with AV-synchronous than with AV-dyssynchronous pacing. However, the extent to which patients profited from AV-synchronous stimulation varied substantially.

Aim of the study Aim of this study is to systematically analyze the impact of diastolic function and other echo parameters on the difference of stroke volumes/cardiac output between AV-synchronous and AV-dyssynchronous pacing modes.

Methods Patients fulfilling the entry criteria will be enrolled (two-chamber pacemaker of any vendor eligible) in this monocentric, prospective, interventional study. Baseline data will be collected with a standardized questionnaire. During an echo examination, parameters of diastolic, systolic and atrial function will be assessed. Then, the stroke volume/cardiac output will be measured twice in each patient, once with AV-synchronous and once with AV-dyssynchronous pacing. Therefore, each patient will represent their own control. It will be randomized (coin tossing) which stimulation mode is first and which is second (sonographer and patient will be blinded). Descriptive statistics will be applied and regression models will be fitted to explore the data.

Detailed Description

Not available

Study Timeline

• Study Start: 2019-06-26
• Study First Submitted: 2019-08-22
• Study First Submitted QC: 2019-08-22
• Study First Posted: 2019-08-28
• Status Verified: 2020-02
• Primary Completion: 2020-02-05
• Study Completion: 2020-02-05
• Last Update Submitted: 2020-02-20
• Last Update Posted: 2020-02-21

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 40

Inclusion Criteria

• Patient is able and willing to give informed consent and is above the age of 18.
• Patient is implanted with a dual chamber pacemaker system for at least 6 weeks.
• Patient is in sinus rhythm on the day of recruitment.
• Patient has a ventricular pacing rate exceeding 90%.
• Upon initial device interrogation, parameters are within normal ranges.
• Calculated battery life is more than 1 year.

Exclusion Criteria

• Patient is not in sinus rhythm on the day of echo examination.
• Intrinsic ventricular activation on the day of echo examination.
• Relevant shunt on the atrial, ventricular or pulmonary level.
• Moderate or severe heart valve dysfunction (stenosis or regurgitation).
• Presence of other medical devices that may interact with the pacemaker system.
• Women who are pregnant or breast feeding.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Eligible patients - pacing mode sequence 1	Pacemaker stimulation mode	Echo assessment of parameters of diastolic function, systolic function, and atrial function. Then, the stroke volume and cardiac output are measured during AV-asynchronous and AV-synchronous pacemaker stimulation: AV-synchronous pacing mode first, then AV-dyssynchronous pacing mode.
Eligible patients - pacing mode sequence 2	Pacemaker stimulation mode	Echo assessment of parameters of diastolic function, systolic function, and atrial function. Then, the stroke volume and cardiac output are measured during AV-asynchronous and AV-synchronous pacemaker stimulation: AV-dyssynchronous pacing mode first, then AV-synchronous pacing mode.

Primary Outcome Measures

Name	Time	Method
Effect of left ventricular diastolic function on the change of cardiac output between AV-synchronous and AV-asynchronous pacing modes.	During echo examination.	Echo parameters of diastolic function.

Secondary Outcome Measures

Name	Time	Method
Effect of baseline characteristics on the change of cardiac output between AV-synchronous and AV-asynchronous pacing modes.	During echo examination.	Demographic variables and co-morbidities.
Effect of atrial function on the change of cardiac output between AV-synchronous and AV-asynchronous pacing modes.	During echo examination.	Echo parameters of atrial function.
Effect of left ventricular systolic function on the change of cardiac output between AV-synchronous and AV-asynchronous pacing modes.	During echo examination.	Echo parameters of systolic function.

Trial Locations

Locations (1)

Kepler University Hospital; 🇦🇹 Linz, Upper Austria, Austria