Left Bundle Area Pacing Vs. Right Ventricular Pacing in Patients With Normal Left Ventricular Function -The Boston Pace Study
Overview
- Phase
- N/A
- Intervention
- Left Bundle Branch Area Pacemaker
- Conditions
- Left Bundle Branch Area Pacing
- Sponsor
- Massachusetts General Hospital
- Enrollment
- 100
- Locations
- 2
- Primary Endpoint
- Change in left ventricular ejection fraction (LVEF)
- Status
- Active, Not Recruiting
- Last Updated
- 2 days ago
Overview
Brief Summary
Right ventricular (RV) pacing can cause left ventricular systolic dysfunction in 10- 20% of patients. Biventricular pacing had previously been shown to prevent left ventricular systolic dysfunction. However, implantation of coronary sinus lead increases procedural risk and can be limited by higher threshold and phrenic nerve capture. HIS pacing has been evaluated as an alternative pacing strategy, but its routine use was limited by difficulty of the procedure, success rate and high pacing threshold.
Left bundle branch area pacing (LBBAP) is a promising physiologic pacing technique that has been proposed as a pacing strategy to prevent pacing induced cardiomyopathy and for treatment of desynchrony in heart failure. LBBAP has been adopted widely and performed routinely on patients with AV block. Currently, it is up to the discretion of the proceduralist whether LBBAP is performed given that there is lack of evidence to guide pacing strategies.
Detailed Description
This pilot trial is a feasibility study that will assess for efficacy, safety and success rate of left bundle branch area pacing. The study will also examine the recruitment rate at 2 major tertiary hospitals. The study will examine if the use of LBBAP can prevent the occurrence of pacing induced cardiomyopathy (PICM) compared to RV pacing among patients with normal left ventricular function and high-grade AV block. The investigators hypothesize that the rate of pacing induced cardiomyopathy is lower with LBBAP compared to RV pacing in patients with normal left ventricular function requiring high burden of RV pacing.
Investigators
Shaan Khurshid
Principal Investigator
Massachusetts General Hospital
Eligibility Criteria
Inclusion Criteria
- •Patients with complete AV block, high-grade AV block with an anticipated ventricular pacing rate of more than 40%
- •Left ventricular ejection fraction of 50% or more.
- •Echocardiogram within the last 3 months
Exclusion Criteria
- •History of systolic dysfunction with LV EF of less than 50%
- •Prior myocardial infarction
- •Obstructive coronary artery disease
- •Severe valvular dysfunction
- •Life expectancy of less than a year
Arms & Interventions
Left Bundle Branch Area Pacing
Intervention: Left Bundle Branch Area Pacemaker
Right Ventricular Pacing
Intervention: Right Ventricular Pacemaker
Outcomes
Primary Outcomes
Change in left ventricular ejection fraction (LVEF)
Time Frame: 12 months
Change in left ventricular end systolic volume (LVESV)
Time Frame: 12 months
Secondary Outcomes
- Success rate of LBBAP(30 days)
- All-cause mortality(12 months)
- Cardiovascular mortality(12 months)
- Rate of heart failure related visit: defined as heart failure hospitalization or emergency room visit or urgent visit requiring intravenous heart failure therapy(12 months)
- Number of participants with upgrade to cardiac resynchronization therapy(12 months)
- New York Heart Association Class I-IV (IV is worst)(12 months)
- Number of participants with occurrence of moderate or severe tricuspid regurgitation on echocardiogram(12 months)
- Number of participants with occurrence of moderate or severe mitral regurgitation on echocardiogram(12 months)
- Number of participants with new onset atrial fibrillation(12 months)
- Kansas City Cardiomyopathy Questionnaire (KCCQ-12) (score of 8-40)(12 months)
- Paced QRS duration on 12 lead EKG(Evaluated at 1 day, 30 days and 12 months)
- Pacing percentage(12 months)
- Complication rate including pneumothorax, cardiac tamponade, infection, and lead revision(12 months)
- Procedure time(1 day)
- Fluoroscopy time(1 day)
- Pacing capture threshold (V)(12 months)
- R wave amplitude (mV)(12 months)
- RV lead impedance (ohms)(12 months)