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Cardiac PacingLEAPNCT04595487

LVSP vs RVP in Patients With AV Conduction Disorders

A study testing Left ventricular septal pacing and Right ventricular pacing in people with Cardiac Pacing and Pacing-Induced Cardiomyopathy, run by Maastricht University at 13 sites in 7 countries.

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 The sponsor has not verified this record for over two years, so it may be out of date.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

Rationale: Permanent cardiac pacing is the only available therapy in patients with atrioventricular (AV) conduction disorders and can be life-saving. Right ventricular pacing (RVP), the routine clinical practice for decades in these patients, is non-physiologic, leads to dyssynchronous electrical and mechanical… Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Left ventricular septal pacing and Right ventricular pacing
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
470 participants
Where
13 sitesin 7 countries
Study dates
1 May 2021to 1 May 2025
Phase
Interventional
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
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age > 18y
  • Life expectancy with good functional status of > 1y
  • Class I or IIa pacemaker indication due to AV conduction disorder
  • Acquired 3rd or 2nd degree AVB
  • Atrial arrhythmia with slow ventricular conduction
  • Expected ventricular pacing percentage > 20%
  • LVEF >/= 40%
  • Signed and dated informed consent form

Who cannot join

  • HF NYHA class III-IV
  • Class I indication for CRT
  • Class I indication for ICD
  • Previous implanted CIED (except for ILR)
  • Atrial arrhythmia with planned AV junction ablation
  • PCI or CABG <30 days before enrollment
Show all 11Show fewer
  • Valvular heart disease with indication for valve repair or replacement
  • Hypertrophic cardiomyopathy with interventricular septum thickness > 2 cm
  • Renal insufficiency requiring hemodialysis
  • Active infectious disease or malignancy
  • Pregnancy

Trial locations and contacts

13 sites in 7 countries.

Justin Luermans, MD PhD contact

+31433875093

justin.luermans@mumc.nl

13 sites in 7 countries

Netherlands6 sites, 6 recruiting
  • Noordwest Ziekenhuisgroep

    Alkmaar

    Stefan Timmer, MD, PhD

    Recruiting
  • Reinier de Graaf Gasthuis

    Delft

    Arnaud Hauer, MD, PhD

    Recruiting
  • Catharina Ziekenhuis

    Eindhoven

    Nard Rademakers, MD, PhD

    Recruiting
  • Medisch Spectrum Twente

    Enschede

    Jurren van Opstal, MD, PhD

    Recruiting
  • Maastricht University

    Maastricht, Limburg, 6229 ER

    Justin Luermans, PhD, justin.luermans@mumc.nl

    Recruiting
  • Sint Antonius Ziekenhuis

    Nieuwegein

    Vincent van Dijk, MD, PhD

    Recruiting

Other trials in Netherlands

Belgium2 sites, 2 recruiting
  • Ziekenhuis Oost Limburg

    Genk

    Wilfried Mullens, MD, PhD

    Not yet recruiting
  • University Hospital Gent

    Ghent

    Jan de Pooter, MD, PhD

    Not yet recruiting

Other trials in Belgium

Czechia1 site, 1 recruiting
  • University Hospital Kralovske Vinohrady

    Prague

    Karol Curila, MD, PhD

    Recruiting

Other trials in Czechia

Italy1 site, 1 recruiting
  • Policlinico Casilino

    Rome

    Domenico Grieco, MD, PhD

    Not yet recruiting

Other trials in Italy

Poland1 site, 1 recruiting
  • University Hospital Jaegellonian

    Krakow

    Marek Jastrzebski, MD, PhD

    Not yet recruiting

Other trials in Poland

Spain1 site, 1 recruiting
  • Hospital Universitario y Politecnico La Fe

    Valencia

    Óscar Cano Pérez, MD, PhD

    Not yet recruiting

Other trials in Spain

Switzerland1 site, 1 recruiting
  • University Hospital of Geneva

    Geneva

    Haran Burri, MD, PhD

    Not yet recruiting

Other trials in Switzerland

About this study

Official title: Permanent Left Ventricular Septal Pacing Versus Right Ventricular Pacing in Patients With Atrioventricular Conduction Disorders: a Randomized Trial: LEAP Trial

Rationale:

Permanent cardiac pacing is the only available therapy in patients with atrioventricular (AV) conduction disorders and can be life-saving. Right ventricular pacing (RVP), the routine clinical practice for decades in these patients, is non-physiologic, leads to dyssynchronous electrical and mechanical activation of the ventricles, and may cause pacing-induced cardiomyopathy and heart failure.

Read more

Left ventricular septal pacing (LVSP) is an emerging form of physiologic pacing that can possibly overcome the adverse effects of RVP.

Study design and hypotheses:

The LEAP trial is a multi-center investigator-initiated, prospective, randomized controlled, open label, blinded endpoint evaluation (PROBE) study that compares LVSP with conventional RVP. A total of four hundred seventy patients with a class I or IIa indication for pacemaker implantation due to AV conduction disorders and an expected ventricular pacing percentage >20% will be randomized 1:1 to LVSP or RVP. The primary endpoint is a composite endpoint of all-cause mortality, hospitalization for heart failure and a more than 10% decrease in left ventricular ejection fraction (LVEF) in absolute terms leading to a LVEF below 50% at one year follow-up. LVSP is anticipated to result in improved outcomes.

Secondary objectives are to evaluate whether LVSP is cost-effective and associated with an improved quality of life (QOL) as compared to RVP. Quality of life is expected to improve with LVSP and reduced healthcare resource utilizations are expected to ensure lower costs in the LVSP group during follow-up, despite initial higher costs of the implantation.

Study design: Multi-center investigator-initiated, prospective, randomized controlled, open label, blinded endpoint evaluation (PROBE) study.

Study population: Adult patients with a bradycardia-pacing indication because of AV conduction disorders with an expected ventricular pacing percentage of ≥ 20% and a left ventricular ejection fraction (LVEF) >/= 40%. Four hundred seventy patients will be randomized 1:1 to LVSP or RVP.

Intervention: LVSP vs RVP.

Main study parameters/endpoints:

The primary endpoint is a composite of all-cause mortality, hospitalization for heart failure, and a more than 10% point decrease in left ventricular ejection fraction (LVEF) leading to an LVEF below 50%, which as a binary combined endpoint will be determined at one year follow-up.

Secondary endpoints are:

  • Time to first occurrence of all cause mortality or hospitalization for heart failure.
  • Time to first occurrence of all cause mortality.
  • Time to first occurrence of hospitalization for heart failure.
  • Time to first occurrence of atrial fibrillation (AF) de novo.
  • The echocardiographic changes in LVEF at one year.
  • The echocardiographic changes in diastolic (dys-)function at one year.
  • The occurrence of pacemaker related complications.
  • Quality of life (QOL), cost-effectiveness analyses (CEA) and budget impact analysis (BIA).

The secondary endpoints (other than echocardiographic LVEF change) will be determined at the end of the follow-up period, when the last included patient has reached one year follow-up. The individual follow-up time for patients at this time point will vary with a minimum of one year.

Being tested
Left ventricular septal pacing, Right ventricular pacing
Medical subject headings
Atrioventricular Block

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Left ventricular septal pacingProcedure or surgery

    In the LVSP group, instead of placing the standard RV lead, the commercially available 3830 Select Secure (Medtronic, Minneapolis, USA) lead is introduced via standard transvenous approach and positioned against the right ventricular side of the IVS by using the commercially available non-deflectable septal delivery sheath (C315, Medtronic, Minneapolis, USA) under fluoroscopic guidance. Subsequently this pacing lead is advanced/screwed through the interventricular septum until the left ventricular septum is reached. Accurate lead position at the left ventricular septum will be determined anatomically using fluoroscopy, and electrically by evaluating local electrograms and changes in paced electrocardiogram morphology.

    In case of unsuccessful lead positioning in the left ventricular septum, the Select Secure lead may be placed at the His bundle region (natural conduction system of the heart) or in the right ventricle according to the physician's discretion.

  • Right ventricular pacingProcedure or surgery

    In the RVP group, the ventricular pacing lead is positioned in the right ventricle.

Study groups in NCT04595487
Study groupRoleWhat they receive
left ventricular septal pacingExperimentalImplantation of a pacemaker with the ventricular lead delivered transvenously through the interventricular septum (IVS) to the left ventricular (LV) septum.
Receives: Procedure: Left ventricular septal pacing
right ventricular pacingActive comparatorImplantation of a pacemaker with the ventricular lead placed in the RV.
Receives: Procedure: Right ventricular pacing

What is being measured

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

  1. Binary combined endpoint consisting of all-cause mortality, hospitalization for heart failure, and a more than 10% point decrease in left ventricular ejection fraction (LVEF) leading to a LVEF below 50%.

    Hospitalization for heart failure is defined as:

    1. hospitalization or unplanned hospital visits for heart failure requiring intravenous diuretics and/or (adjustment of) other medical heart failure therapy;
    2. hospitalization for upgrade to cardiac resynchronization therapy (CRT, ie biventricular pacing) for progression of heart failure with worsening NYHA class and/or (increased) need for diuretic therapy or other medical heart failure therapy;
    3. or hospitalization for upgrade to CRT for developing a class I indication for CRT (includes symptomatic heart failure);
    4. or hospitalization or unplanned hospital visit for heart failure triggered by an episode of atrial fibrillation with uncontrolled heart rate requiring intravenous diuretics or adjustment of rate control therapy.

    All-cause mortality is defined as death from any cause and subdivided into cardiovascular and non-cardiovascular death.

    Measured: Determined at one year follow-up

Secondary outcomes (10)
  1. Time to first occurrence of hospitalization for heart failure.

    Hospitalization for heart failure is defined as:

    1. hospitalization or unplanned hospital visits for heart failure requiring intravenous diuretics and/or (adjustment of) other medical heart failure therapy;
    2. hospitalization for upgrade to cardiac resynchronization therapy (CRT, ie biventricular pacing) for progression of heart failure with worsening NYHA class and/or (increased) need for diuretic therapy or other medical heart failure therapy;
    3. or hospitalization for upgrade to CRT for developing a class I indication for CRT (includes symptomatic heart failure);
    4. or hospitalization or unplanned hospital visit for heart failure triggered by an episode of atrial fibrillation with uncontrolled heart rate requiring intravenous diuretics or adjustment of rate control therapy.

    Measured: Determined at the end of the follow-up period (when the last-included patient reached the one year follow-up period)

  2. Time to first occurrence of all cause mortality.

    All-cause mortality is defined as death from any cause and subdivided into cardiovascular and non-cardiovascular death.

    Measured: Determined at the end of the follow-up period (when the last-included patient reached the one year follow-up period)

  3. Time to first occurrence of all cause mortality or hospitalization for heart failure.

    All cause mortality and hospitalization for heart failure are defined as mentioned in secondary outcome 1 and 2.

    Measured: Determined at the end of the follow-up period (when the last-included patient reached the one year follow-up period)

  4. Time to first occurrence of atrial fibrillation (AF) de novo.

    Occurrence of atrial fibrillation de novo is defined as:

    Occurrence of a first clinical or subclinical episode of AF as diagnosed respectively by ECG (clinical AF) or by pacemaker interrogation (subclinical AF/atrial high rate episode, lasting > 24 hours) in patients without a history of AF.

    Measured: Determined at the end of the follow-up period (when the last-included patient reached the one year follow-up period)

  5. The echocardiographic changes in left ventricular ejection fraction (LVEF) at one year.

    Change in LVEF is based on echocardiography at one year follow-up as compared to baseline echocardiography.

    Measured: Determined at one year follow-up

  6. The echocardiographic changes in diastolic (dys-)function at one year.

    Diastolic function will be assessed by determining the following echocardiographic parameters at baseline and one year follow-up: E-wave, A-wave, E/A ratio, e' septal and lateral, E/e', 2D-strain of the left ventricle and atrium, pressure gradient across the tricuspid valve (dPTI) and volume of the left-atrium (LAVI). Diastolic function will be graded according to the current guidelines.

    Measured: Determined at one year follow-up

  7. The occurrence of pacemaker related complications.

    Pacemaker (implantation) related complications occurring during pacemaker implantation or during follow-up after pacemaker implantation consisting of: pneumothorax; cardiac tamponade; pocket hematoma requiring re-intervention; pacemaker infection; lead luxation, dislocation, or perforation requiring re-intervention; pacemaker and lead dysfunction during follow-up (elevated threshold/sensing issues/early battery depletion) requiring re-intervention.

    Measured: Determined at the end of the follow-up period (when the last-included patient reached the one year follow-up period)

  8. Quality of Life analysis reported as Quality Adjusted Life Years (QALYs)

    Quality of life will be analyzed using the EQ-5D-5L questionnaire at baseline, 6 and 12 months follow-up and every 6 months thereafter.

    Measured: Determined at the end of the follow-up period (when the last-included patient reached the one year follow-up period)

  9. Cost effectiveness analysis (CEA)

    A trial based economical evaluation from a societal perspective will be performed in accordance with the Dutch guidelines for economical evaluations in healthcare.

    Resource use will be measured from a societal perspective using data from case record forms and the Medical Consumption (MCQ) and Productivity loss (PCQ) questionnaires.

    Measured: Determined at the end of the follow-up period (when the last-included patient reached the one year follow-up period)

  10. Budget Impact Analysis (BIA)

    Budget impact analysis will be performed from a societal, health care provider and health care insurer perspective. The eligible population will be estimated based on national health care data.

    Costs of the intervention and heart failure costs will be included. Indirect costs will not be included. The time horizon will be 3 years. The expected uptake rate will be estimated based on a panel of experts (cardiologists, implementation specialist, patient representatives) and analyses will be performed for this expected uptake rate and several slightly higher and lower uptake rates. Uncertainties and scenarios will be discussed in a panel of experts as well and different scenarios will be analysed. Recommendations of the ISPOR task force are followed for all BIA calculations.

    Measured: Determined at the end of the follow-up period (when the last-included patient reached the one year follow-up period)

Timeline

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

  1. First posted20 Oct 2020
  2. Study start1 May 2021
  3. Primary completion1 May 2025 (estimated)
  4. Study completion1 May 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
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
470 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04595487
Sponsor's protocol ID
NL72047.068.20
Acronym
LEAP
Status last verified
Apr 2024
First submitted
1 Oct 2020
Last updated
15 Apr 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing Left ventricular septal pacing and Right ventricular pacing in people with Cardiac Pacing and Pacing-Induced Cardiomyopathy, run by Maastricht University at 13 sites in 7 countries.

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 8 inclusion and 11 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 15 Apr 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 13 sites in Netherlands, Belgium, Czechia, Italy, Poland and 2 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.

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 Justin Luermans, MD PhD (+31433875093, justin.luermans@mumc.nl), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Binary combined endpoint consisting of all-cause mortality, hospitalization for heart failure, and a more than 10% point decrease in left ventricular ejection fraction (LVEF) leading to a LVEF below 50%. (time frame: Determined at one year follow-up). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 15 Apr 2024.

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