Outcomes and Safety of Various Conduction System Pacing Methods

AV Block Clinical Trial

Official title:

Registry of His Bundle, Bachmann Bundle and Left Bundle Branch Area Pacing for Various Pacing Indications

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04749836
• Other study ID #: Conduction pacing Registry
• Status: Recruiting
• Start date: February 4, 2021
• Est. completion date: December 1, 2024

Study information

• Verified date: January 2024
• Source: University Medical Centre Ljubljana
• Contact: David Žižek, Assist. Prof.
• Phone: +38615228534
• Email: david.zizek[@]kclj.si
• Is FDA regulated: No
• Study type: Observational [Patient Registry]

Clinical Trial Summary

The aim of this study is to evaluate safety and clinical outcomes after different pacing approaches of conduction system pacing in a prospective registry.

Description:

In comparison with right ventricular pacing-induced electromechanical dyssynchrony, conduction system pacing is providing physiological pacing via His-Purkinje activation. Current approaches include His bundle (HBP), left bundle branch area pacing (LBBAP), and Bachmann bundle pacing. In addition, HBP and LBBAP enable correction of underlying proximal bundle branch block, consequently improving the ventricular activation time and narrowing the QRS. Furthermore, atrial activation can be improved with direct Bachmann bundle stimulation. However, the data regarding long-term performance and safety of these physiological approaches in various clinical scenarios is scarce.

With this registry, the investigators would like to obtain real-world data regarding the feasibility and safety of this physiological pacing approaches in various pacing indications and their implementation in routine clinical practice.

Implant success rate, specific implant characteristics, procedural complications, electrical parameters and clinical outcomes will be analyzed at implantation, 1-3 months after inclusion and every 6 months thereafter. Minimal follow-up will be 2 years.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 150
• Est. completion date: December 1, 2024
• Est. primary completion date: December 1, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 5 Years to 85 Years

Eligibility

Inclusion Criteria:

• Class I and II indications for permanent pacing

• Atrial fibrillation with uncontrolled ventricular rate for pace and ablate strategy

• Bundle branch block correction for HF patients

• Patients with prolonged PR interval and dromotropathy

Related Conditions & MeSH terms

• Atrial Fibrillation
• Atrial Fibrillation Rapid
• AV Block
• Bundle-Branch Block

Intervention

Procedure:
• His bundle pacing implantation, Left bundle branch area pacing implantation, Bachmann bundle pacing
Different active fixation leads and the dedicated delivery sheaths are introduced via standard transvenous approach under fluoroscopic guidance. His bundle potential mapping is performed in a unipolar setting with the use of the electrophysiological system for His bundle pacing. After localizing the His bundle potential, the pacing is attempted before the lead fixation to confirm HB capture. The lead is then screwed into position. Acute HBP threshold = 2.5V at 1ms is considered acceptable. On the other hand, the initial site for LBBP is approximately 1-1.5 cm distal to the HBP lead position in the RV septum along the line between the HBP site and RV apex in the right anterior oblique (30°) fluoroscopic view. Bachmann bundle pacing (upper atrial septum) will be performed with the J-stylet modification technique or with specialized catheter method using the SelectSecure active fixation lead. Stepwise approach for conduction pacing will also be tested.

Locations

Country	Name	City	State
Slovenia	University Medical Centre Ljubljana - Cardiology department	Ljubljana

Sponsors (1)

Lead Sponsor	Collaborator
University Medical Centre Ljubljana

Country where clinical trial is conducted

Slovenia, 

References & Publications (14)

Beck H, Curtis AB. Right Ventricular Versus Biventricular Pacing for Heart Failure and Atrioventricular Block. Curr Heart Fail Rep. 2016 Oct;13(5):230-236. doi: 10.1007/s11897-016-0299-3. — View Citation

Boriani G, Pieragnoli P, Botto GL, Puererfellner H, Mont L, Ziacchi M, Manolis AS, Gulizia M, Tukkie R, Landolina M, Ricciardi G, Cicconelli M, Grammatico A, Biffi M. Effect of PR interval and pacing mode on persistent atrial fibrillation incidence in dual chamber pacemaker patients: a sub-study of the international randomized MINERVA trial. Europace. 2019 Apr 1;21(4):636-644. doi: 10.1093/europace/euy286. — View Citation

Curtis AB, Worley SJ, Chung ES, Li P, Christman SA, St John Sutton M. Improvement in Clinical Outcomes With Biventricular Versus Right Ventricular Pacing: The BLOCK HF Study. J Am Coll Cardiol. 2016 May 10;67(18):2148-2157. doi: 10.1016/j.jacc.2016.02.051. — View Citation

Das A, Banerjee S, Mandal SC. A simple method for Bachmann's bundle pacing with indigenous modification of J-stylet. Indian Heart J. 2016 Sep-Oct;68(5):678-684. doi: 10.1016/j.ihj.2015.10.299. Epub 2016 Jan 11. — View Citation

Gu M, Hu Y, Hua W, Niu H, Chen X, Cai M, Zhang N, Li H, Zhou X, Zhang S. Visualization of tricuspid valve annulus for implantation of His bundle pacing in patients with symptomatic bradycardia. J Cardiovasc Electrophysiol. 2019 Oct;30(10):2164-2169. doi: 10.1111/jce.14140. Epub 2019 Aug 31. — View Citation

Jastrzebski M, Moskal P, Bednarek A, Kielbasa G, Czarnecka D. His-bundle pacing as a standard approach in patients with permanent atrial fibrillation and bradycardia. Pacing Clin Electrophysiol. 2018 Nov;41(11):1508-1512. doi: 10.1111/pace.13490. Epub 2018 Sep 19. — View Citation

Keene D, Arnold AD, Jastrzebski M, Burri H, Zweibel S, Crespo E, Chandrasekaran B, Bassi S, Joghetaei N, Swift M, Moskal P, Francis DP, Foley P, Shun-Shin MJ, Whinnett ZI. His bundle pacing, learning curve, procedure characteristics, safety, and feasibility: Insights from a large international observational study. J Cardiovasc Electrophysiol. 2019 Oct;30(10):1984-1993. doi: 10.1111/jce.14064. Epub 2019 Aug 2. — View Citation

Ponnusamy SS, Arora V, Namboodiri N, Kumar V, Kapoor A, Vijayaraman P. Left bundle branch pacing: A comprehensive review. J Cardiovasc Electrophysiol. 2020 Sep;31(9):2462-2473. doi: 10.1111/jce.14681. Epub 2020 Jul 30. — View Citation

Sharma AD, Rizo-Patron C, Hallstrom AP, O'Neill GP, Rothbart S, Martins JB, Roelke M, Steinberg JS, Greene HL; DAVID Investigators. Percent right ventricular pacing predicts outcomes in the DAVID trial. Heart Rhythm. 2005 Aug;2(8):830-4. doi: 10.1016/j.hrthm.2005.05.015. — View Citation

Sharma PS, Vijayaraman P, Ellenbogen KA. Permanent His bundle pacing: shaping the future of physiological ventricular pacing. Nat Rev Cardiol. 2020 Jan;17(1):22-36. doi: 10.1038/s41569-019-0224-z. Epub 2019 Jun 27. Erratum In: Nat Rev Cardiol. 2019 Dec;16(12):760. — View Citation

Steinberg JS, Fischer A, Wang P, Schuger C, Daubert J, McNitt S, Andrews M, Brown M, Hall WJ, Zareba W, Moss AJ; MADIT II Investigators. The clinical implications of cumulative right ventricular pacing in the multicenter automatic defibrillator trial II. J Cardiovasc Electrophysiol. 2005 Apr;16(4):359-65. doi: 10.1046/j.1540-8167.2005.50038.x. — View Citation

Vijayaraman P, Bordachar P, Ellenbogen KA. The Continued Search for Physiological Pacing: Where Are We Now? J Am Coll Cardiol. 2017 Jun 27;69(25):3099-3114. doi: 10.1016/j.jacc.2017.05.005. — View Citation

Vijayaraman P, Chung MK, Dandamudi G, Upadhyay GA, Krishnan K, Crossley G, Bova Campbell K, Lee BK, Refaat MM, Saksena S, Fisher JD, Lakkireddy D; ACC's Electrophysiology Council. His Bundle Pacing. J Am Coll Cardiol. 2018 Aug 21;72(8):927-947. doi: 10.1016/j.jacc.2018.06.017. — View Citation

Vijayaraman P, Dandamudi G. Anatomical approach to permanent His bundle pacing: Optimizing His bundle capture. J Electrocardiol. 2016 Sep-Oct;49(5):649-57. doi: 10.1016/j.jelectrocard.2016.07.003. Epub 2016 Jul 11. — View Citation

* Note: There are 14 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Acute and long-term implant success rate	Ventricular activation occurring over the conduction system with acceptable pacing threshold	through study completion, an average of 2 years
Secondary	Pacing parameters	Capture threshold, R waves, lead impedance, QRS morphology	peri-procedural
Secondary	Stepwise approach of pacing modes	Proportion of patients with HBP as a first option and LBBA as a fist option	peri-procedural
Secondary	Pacing lead stability	Lead threshold fluctuation	through study completion, an average of 2 years
Secondary	Heart failure hospitalisation	Incidence of heart failure hospitalizations after device implantation	through study completion, an average of 2 years
Secondary	Echocardiographic measurements	Assessment of cardiac function	through study completion, an average of 1 year
Secondary	Procedural characteristics	Total procedure and fluoroscopy time in minutes	peri-procedural