Ventricular Dysfunction Clinical Trial
Official title:
Multiparametric CMR Assessment of Apical Versus Septal Pacing Study
Despite considerable effort the optimal site to place a pacemaker lead at the time of
pacemaker implant remains unclear. Historically pacemaker leads have always been inserted at
the bottom (apex) of the heart. It is suggested that a lead placed at the apex is associated
with an increase in heart rhythm problems and also heart failure (impaired pumping function).
The top of the ventricle (septum) has been investigated as an alternative site and is now
routinely used by some centres. Previous estimation of the hearts pumping function (ejection
fraction) has been limited to the use of echo (sound waves). Echo is not sensitive enough to
detect small changes in the ejection fraction reliably (measure of pumping function of
heart). The gold standard for measurement of ejection fraction is MRI (using magnets).
Previous pacemakers have not been compatible with MRI scans. The latest generation of
pacemakers are now able to be safely scanned within an MRI scanner. This allows a much more
accurate estimation of the effects of a pacemaker on the ejection fraction which has not yet
been studied.
The investigators plan to study those patients undergoing a pacemaker implant and ablation
procedure as part of their standard care.
Individuals will have an exercise test, blood test used to measure biomarkers and fill in a
symptom questionnaire.
Individuals will have a Cardiac MR compatible pacemaker fitted and 2 ventricular leads will
be inserted, one apically and one septally. Only one lead will be used at any given time.
Individuals will then undergo their planned AV node ablation.
Following this they will have a cardiac MR scan. Further MRI scans will be performed at 9 and
18 month intervals, as will symptom questionnaires, blood tests (BNP) to determine heart
muscle strain, exercise testing and echocardiograms.
The hypothesis is that a lead placed on the septum will produce superior cardiac performance
over the short and long term.
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