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Left Bundle-Branch BlockNCT04328649

Clinical, Structural and Mechanical Features in Patients With Left Bundle Branch Block.

An observational study of Left Bundle-Branch Block and Electrocardiographic Pattens, run by Policlinico Casilino ASL RMB.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Clinical, structural and mechanical features in patients with left bundle branch block. Read more about this study

Who is it for?
Ages 18 years and older
How many people
250 participants
Where
No sites listed yet
Study dates
15 May 2020to 15 Apr 2025
How long will I take part?
5 Years
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Adult, Older adult

Study population: In this prospective observational study we consider to enroll patients with LBBB admitted to our Cardiology Department and Ambulatory Care Unit recording different ECG patterns, risk factors, genetic, underlying heart disease, imaging parameters (Echocardiographic and Cardiac Magnetic Resonance) and treatment (either pharmacological or interventional).

Who may be able to join

  • Every patient with electrocardiographic diagnosis of LBBB admitted to our Cardiology Department and Ambulatory Care Unit
  • ECG standard criteria from typical, atypical and NIVCD
  • Patients who have given their informed consent in writing.
  • Age ≥ 18 years

Who cannot join

  • Age <18 years
  • Patients who have not given their informed consent in writing.

Trial locations and contacts

No sites are listed yet.

Leonardo Calò, Professor contact

0623188406

leonardo.calo@gmail.com

Leonardo Calò, Professor contact

0623188406

About this study

Official title: Clinical, Structural and Mechanical Features in Patients With Left Bundle Branch Block: an Observational and Prospective Study.

Clinical, structural and mechanical features in patients with left bundle branch block.

Read the detailed description

Left bundle-branch block (LBBB) is an electrocardiographic marker often associated with underlying cardiac disease (such as coronary artery disease, dilated cardiomyopathy, etc) but in some cases it is also found in patients with isolated LBBB defined as "none apparent structural heart disease".

Several investigations in animal and human study have showed a different electroanatomical activation in isolated LBBB when compared to LBBB in heart failure patients mostly due to coronary artery disease. The sequence of endocardial activation through the left ventricle has also proven to be heterogeneous in heart failure occuring at different septal regions. This electrical and mechanical variability seems to be related to location of LBBB block or lesion that could be proximal, distal or diffuse, consequently influencing also electrocardiographic aspects.

These considerations explain and justify the great variability in the proposed "true or typical LBBB" definitions (derived from from Strauss, Perrin and Marican definitions and from Heart Association/American College Cardiology Foundation/ European Society of Cardiology guidelines) but also shift attention to relatively new concept of atypical LBBB definitions with extreme left or right axis deviation and of non specific intraventricular conduction delay defined as a wide QRS (≥110 ms) without the appearance of left and right bundle-branch block. In fact, several investigations have shown that QRS axis deviation is a predictor of unfavorable outcome after cardiac resynchronization therapy and LBBB. The less favorable outcome of cardiac resynchronization therapy candidates with LBBB and left axis deviation seems to be associated to the presence of a shorter activation delay, scar tissue and left ventricular hypertrophy. Moreover, actual LBBB definitions recommended by guidelines in cardiac resynchronization therapy patients differ significantly and only individual ECG criteria (such as electrocardiographic intervals QS or RS in lead V1, notch and no q wave in lead V5, V6, I and avL) seems to be associated to clinical outcome when compared with combining criteria.

Finally, a frequent dyssynchrony of ventricular activation due to LBBB may be responsible for a dyssynchrony-related cardiomyopathy that needs to be identified early and differentiated from other forms of dilated cardiomyopathy through a multiparametric approach such as genetic, clinical data, electrocardiography and cardiac magnetic resonance. In fact, in isolated LBBB undergone cardiac magnetic resonance it was observed a greater left ventricular volumes and lower global left ventricular Ejection Fraction despite the absence of cardiovascular disease as compared with control subject. Despite this, comparison between isolated LBBB and structural heart disease shows a different myocardial mechanism all the more unfavourable the more significant is the presence of underlying myocardial scarring. In the other hand, isolated LBBB, dyssynchrony-related cardiomyopathy and myocardial scarring could present different temporal phase in the clinical history of the same patient and that must be early identified.

The aim of this present large-scale prospective observational study is to evaluate 1) clinical, electrocardiographic and imaging features in a population of patients with typical and atypical LBBB and " non specific intraventricular conduction delay" pattern during a long-term follow up and 2) association among eventual different LBBB patterns (typical, atypical (LBBB and extreme left and/or right axis deviation, fragmentation) and " non specific intraventricular conduction delay " pattern and tissue characterization, mechanical myocardial activation and perfusion. 3) a possible time-related evolution from "non specific intraventricular conduction delay" patterns to typical or atypical LBBB.

Medical subject headings
Bundle-Branch Block

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Rate of ECG pattern distribution in LBBB patients

    Measured: 5 years

  2. Rate of underlying structural heart diseases in different LBBB pattern

    Measured: 5 years

  3. Number of participants with stress induced myocardial ischemia during Stress Magnetic resonance

    Measured: 5 years

  4. number or participants with late gadolinium enhancement during cardiac magnetic resonance

    Measured: 5 years

  5. number and of participants with isolated LBBB evolving to dyssynchrony-related cardiomyopathy

    Measured: 5 years

  6. Number of participants with mechanical dyssynchrony evaluated with Echocardiography

    Strain, Strain Rate, intraventricular timing Delay between left ventricular lateral and Septal wall

    Measured: 5 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted31 Mar 2020
  2. Study start15 May 2020 (estimated)
  3. Primary completion15 Apr 2022 (estimated)
  4. Study completion15 Apr 2025 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
250 participants (estimated)
Target duration
5 Years
IDs, dates and publications
ClinicalTrials.gov ID
NCT04328649
Sponsor's protocol ID
PoliclinicoCasilino
Status last verified
May 2020
First submitted
26 Mar 2020
Last updated
6 May 2020
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Akhtari S, Chuang ML, Salton CJ, Berg S, Kissinger KV, Goddu B, O'Donnell CJ, Manning WJ. Effect of isolated left bundle-branch block on biventricular volumes and ejection fraction: a cardiovascular magnetic resonance assessment. J Cardiovasc Magn Reson. 2018 Sep 20;20(1):66. doi: 10.1186/s12968-018-0457-8.

    PubMed 30231875
  • Strik M, Regoli F, Auricchio A, Prinzen F. Electrical and mechanical ventricular activation during left bundle branch block and resynchronization. J Cardiovasc Transl Res. 2012 Apr;5(2):117-26. doi: 10.1007/s12265-012-9351-1. Epub 2012 Feb 7.

    PubMed 22311563
  • Surawicz B, Childers R, Deal BJ, Gettes LS, Bailey JJ, Gorgels A, Hancock EW, Josephson M, Kligfield P, Kors JA, Macfarlane P, Mason JW, Mirvis DM, Okin P, Pahlm O, Rautaharju PM, van Herpen G, Wagner GS, Wellens H; American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; American College of Cardiology Foundation; Heart Rhythm Society. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol. 2009 Mar 17;53(11):976-81. doi: 10.1016/j.jacc.2008.12.013. No abstract available.

    PubMed 19281930
  • European Society of Cardiology (ESC); European Heart Rhythm Association (EHRA); Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, Cleland J, Deharo JC, Delgado V, Elliott PM, Gorenek B, Israel CW, Leclercq C, Linde C, Mont L, Padeletti L, Sutton R, Vardas PE. 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Europace. 2013 Aug;15(8):1070-118. doi: 10.1093/europace/eut206. Epub 2013 Jun 24. No abstract available.

    PubMed 23801827
  • Strauss DG, Selvester RH, Wagner GS. Defining left bundle branch block in the era of cardiac resynchronization therapy. Am J Cardiol. 2011 Mar 15;107(6):927-34. doi: 10.1016/j.amjcard.2010.11.010.

    PubMed 21376930
  • Padanilam BJ, Morris KE, Olson JA, Rippy JS, Walsh MN, Subramanian N, Vidal A, Prystowsky EN, Steinberg LA. The surface electrocardiogram predicts risk of heart block during right heart catheterization in patients with preexisting left bundle branch block: implications for the definition of complete left bundle branch block. J Cardiovasc Electrophysiol. 2010 Jul;21(7):781-5. doi: 10.1111/j.1540-8167.2009.01714.x. Epub 2010 Feb 1.

    PubMed 20132380
  • Kisiel R, Fijorek K, Moskal P, Kukla P, Pavlinec C, Stec J, Czarnecka D, Jastrzebski M. True left bundle branch block and long-term mortality in cardiac resynchronisation therapy patients. Kardiol Pol. 2019;77(3):371-379. doi: 10.5603/KP.a2019.0032. Epub 2019 Feb 25.

    PubMed 30799545
  • Eschalier R, Ploux S, Ritter P, Haissaguerre M, Ellenbogen KA, Bordachar P. Nonspecific intraventricular conduction delay: Definitions, prognosis, and implications for cardiac resynchronization therapy. Heart Rhythm. 2015 May;12(5):1071-9. doi: 10.1016/j.hrthm.2015.01.023. Epub 2015 Jan 19.

    PubMed 25614250
  • Storkas HS, Hansen TF, Tahri JB, Lauridsen TK, Olsen FJ, Borgquist R, Vinther M, Lindhardt TB, Bruun NE, Sogaard P, Risum N. Left axis deviation in patients with left bundle branch block is a marker of myocardial disease associated with poor response to cardiac resynchronization therapy. J Electrocardiol. 2020 Nov-Dec;63:147-152. doi: 10.1016/j.jelectrocard.2019.04.007. Epub 2019 Apr 5.

    PubMed 31003852
  • van Stipdonk AMW, Hoogland R, Ter Horst I, Kloosterman M, Vanbelle S, Crijns HJGM, Prinzen FW, Meine M, Maass AH, Vernooy K. Evaluating Electrocardiography-Based Identification of Cardiac Resynchronization Therapy Responders Beyond Current Left Bundle Branch Block Definitions. JACC Clin Electrophysiol. 2020 Feb;6(2):193-203. doi: 10.1016/j.jacep.2019.10.009. Epub 2019 Nov 27.

    PubMed 32081223
  • Sanna GD, Merlo M, Moccia E, Fabris E, Masia SL, Finocchiaro G, Parodi G, Sinagra G. Left bundle branch block-induced cardiomyopathy: a diagnostic proposal for a poorly explored pathological entity. Int J Cardiol. 2020 Jan 15;299:199-205. doi: 10.1016/j.ijcard.2019.06.008. Epub 2019 Jun 4.

    PubMed 31186131
  • Strauss DG, Selvester RH. The QRS complex--a biomarker that "images" the heart: QRS scores to quantify myocardial scar in the presence of normal and abnormal ventricular conduction. J Electrocardiol. 2009 Jan-Feb;42(1):85-96. doi: 10.1016/j.jelectrocard.2008.07.011. Epub 2008 Sep 13. No abstract available.

    PubMed 18790501

Questions about this trial

What is this clinical trial studying?

An observational study of Left Bundle-Branch Block and Electrocardiographic Pattens, run by Policlinico Casilino ASL RMB.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 6 May 2020. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Leonardo Calò, Professor (0623188406, leonardo.calo@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Rate of ECG pattern distribution in LBBB patients (time frame: 5 years). The study lists 6 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04328649, which also lists 12 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 May 2020.

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