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Heart Failure With Reduced Ejection FractionNCT06342492

Conduction System Vs Surgical Left Ventricular Epicardial Pacing For Coronary Sinus Lead Failure

An observational study of Heart Failure With Reduced Ejection Fraction, run by Kansas City Heart Rhythm Research Foundation at 1 site in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

This a single-center, retrospective, observational study of patients that undergo coronary sinus(CS) lead revision, comparing epicardial lead placement to coronary sinus pacing(CSP) in those that had lead failure. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Coronary Sinus Lead Revision
How many people
100 participants
Where
1 siteUnited States
Study dates
7 Nov 2023to Dec 2024
Phase
Observational
Are there results?
Not yet: the study is under way

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

Study population: Adults who underwent CS lead revision, comparing epicardial lead placement to CSP in those that had lead failure.

Who may be able to join

  • All patients older than 18 years of age
  • Patients with HFrEF that underwent BVP-CRT
  • Experienced CS lead failure, whether initial or recurrent, subsequently replaced with transthoracic epicardial lead placement or CSP
  • Underwent Medtronic, Boston Scientific, or Abbott lead placement

Who cannot join

  • Patients younger than 18 years of age
  • Transthoracic epicardial lead placement or CSP performed as the initial approach or for other reasons than lead replacement
  • Those for which CRT no longer provides symptom relief or mortality benefit.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Donita Atkins contact

816-651-1969

datkins@kchrf.com

United States1 site, 1 recruiting

  • Kansas City Heart Rhythm Institute

    Overland Park, Kansas, 66211

    Donita Atkins, 816-651-1969, Datkins@kchrf.com

    Naga Venkata K. Pothineni, MD

    Recruiting

Other trials in United States

About this study

This a single-center, retrospective, observational study of patients that undergo coronary sinus(CS) lead revision, comparing epicardial lead placement to coronary sinus pacing(CSP) in those that had lead failure.

Read the detailed description

Cardiac resynchronization therapy with defibrillator(CRT-D) improves quality of life, functionality, and even mortality for select patients with severe heart failure with reduced ejection fraction (HFrEF). It traditionally consists of three leads placed endovascularly into the right atrium, right ventricle, and left ventricle (LV) [typically placed into the CS], known as biventricular pacing resynchronization (BVP-CRT), respectively, from which electrical stimulation enables improved cardiac synchrony. Nonetheless, the placement of a CRT-D is not without risks. Lead-related complication is high and CRT-D implantation fails in up to 30% of patients due to lead placement alone.

Epicardial lead placement and CSP have been deemed viable alternatives to CRT-D. It has even been shown to be options in patients that fail conventional BVP-CRT. This is primarily due to increased accuracy, decreased complications, and even durability. However, guidelines for decision between a transthoracic approach and CSP is unclear, even more so after lead failure. Instead, this decision is currently individualized to the patient. There is a lack of prospective and head-to-head data between the two, and this study is aimed to compare transthoracic LV epicardial lead placement and CSP in patients with lead failure after BVP-CRT.

Being tested
Coronary Sinus Lead Revision

What participants receive

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

  • Coronary Sinus Lead RevisionOther

    Coronary Sinus Lead Revision

Study groups in NCT06342492
Study groupRoleWhat they receive
Conduction System PacingSubjects who had lead placement via conduction system pacing approach
Receives: Other: Coronary Sinus Lead Revision
Epicardial Lead PlacementSubjects who had lead placement via transthoracic, epicardial approach
Receives: Other: Coronary Sinus Lead Revision

What is being measured

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

  1. Need for lead revision

    Compare the need for lead revision between conduction system pacing (CSP) and transthoracic left ventricular (LV) epicardial pacing approach

    Measured: Procedure Day

Secondary outcomes (1)

  1. Electrocardiography characteristics - QRS Interval

    Compare electrocardiography characteristics - QRS Interval measured in seconds between conduction system pacing (CSP) and transthoracic left ventricular (LV) epicardial pacing approach

    Measured: Procedure Day

Timeline

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

  1. First posted2 Apr 2024
  2. Study start7 Nov 2023
  3. Primary completionNov 2024 (estimated)
  4. Study completionDec 2024 (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
Retrospective
Enrolment
100 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06342492
Sponsor's protocol ID
KCHRRF_CS Lead Failure_0025
Status last verified
Oct 2024
First submitted
6 Feb 2024
Last updated
28 Oct 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, Kocovic DZ, Packer M, Clavell AL, Hayes DL, Ellestad M, Trupp RJ, Underwood J, Pickering F, Truex C, McAtee P, Messenger J; MIRACLE Study Group. Multicenter InSync Randomized Clinical Evaluation. Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002 Jun 13;346(24):1845-53. doi: 10.1056/NEJMoa013168.

    PubMed 12063368

  • Butter C, Georgi C, Stockburger M. Optimal CRT Implantation-Where and How To Place the Left-Ventricular Lead? Curr Heart Fail Rep. 2021 Oct;18(5):329-344. doi: 10.1007/s11897-021-00528-9. Epub 2021 Sep 8.

    PubMed 34495452

  • Daubert C, Behar N, Martins RP, Mabo P, Leclercq C. Avoiding non-responders to cardiac resynchronization therapy: a practical guide. Eur Heart J. 2017 May 14;38(19):1463-1472. doi: 10.1093/eurheartj/ehw270.

    PubMed 27371720

  • Pothineni NVK, Gondi S, Cherian T, Kovelamudi S, Schaller RD, Lakkireddy D, Gopinathannair R, Deshmukh A. Complications of Cardiac Resynchronization Therapy: Comparison of Safety Outcomes from Real-world Studies and Clinical Trials. J Innov Card Rhythm Manag. 2022 Aug 15;13(8):5121-5125. doi: 10.19102/icrm.2022.130805. eCollection 2022 Aug.

    PubMed 36072440

  • Alonso C, Leclercq C, d'Allonnes FR, Pavin D, Victor F, Mabo P, Daubert JC. Six year experience of transvenous left ventricular lead implantation for permanent biventricular pacing in patients with advanced heart failure: technical aspects. Heart. 2001 Oct;86(4):405-10. doi: 10.1136/heart.86.4.405.

    PubMed 11559679

  • Ahsan SY, Saberwal B, Lambiase PD, Chaubey S, Segal OR, Gopalamurugan AB, McCready J, Rogers DP, Lowe MD, Chow AW. An 8-year single-centre experience of cardiac resynchronisation therapy: procedural success, early and late complications, and left ventricular lead performance. Europace. 2013 May;15(5):711-7. doi: 10.1093/europace/eus401. Epub 2013 Jan 12.

    PubMed 23315159

  • Navia JL, Atik FA, Grimm RA, Garcia M, Vega PR, Myhre U, Starling RC, Wilkoff BL, Martin D, Houghtaling PL, Blackstone EH, Cosgrove DM. Minimally invasive left ventricular epicardial lead placement: surgical techniques for heart failure resynchronization therapy. Ann Thorac Surg. 2005 May;79(5):1536-44; discussion 1536-44. doi: 10.1016/j.athoracsur.2004.10.041.

    PubMed 15854930

  • Sharma PS, Vijayaraman P. Conduction System Pacing for Cardiac Resynchronisation. Arrhythm Electrophysiol Rev. 2021 Apr;10(1):51-58. doi: 10.15420/aer.2020.45.

    PubMed 33936744

  • Chen X, Ye Y, Wang Z, Jin Q, Qiu Z, Wang J, Qin S, Bai J, Wang W, Liang Y, Chen H, Sheng X, Gao F, Zhao X, Fu G, Ellenbogen KA, Su Y, Ge J. Cardiac resynchronization therapy via left bundle branch pacing vs. optimized biventricular pacing with adaptive algorithm in heart failure with left bundle branch block: a prospective, multi-centre, observational study. Europace. 2022 May 3;24(5):807-816. doi: 10.1093/europace/euab249.

    PubMed 34718539

  • Burger H, Pecha S, Hakmi S, Opalka B, Schoenburg M, Ziegelhoeffer T. Five-year follow-up of transvenous and epicardial left ventricular leads: experience with more than 1000 leads. Interact Cardiovasc Thorac Surg. 2020 Jan 1;30(1):74-80. doi: 10.1093/icvts/ivz239.

    PubMed 31633187

  • Kim HR, Lim K, Park SJ, Park JS, Kim JY, Chung S, Jung DS, Park KM, On YK, Kim JS. Thoracoscopic Implantation of Epicardial Left Ventricular Lead for Cardiac Resynchronization Therapy. J Cardiovasc Dev Dis. 2022 May 16;9(5):160. doi: 10.3390/jcdd9050160.

    PubMed 35621871

  • Wu S, Su L, Vijayaraman P, Zheng R, Cai M, Xu L, Shi R, Huang Z, Whinnett ZI, Huang W. Left Bundle Branch Pacing for Cardiac Resynchronization Therapy: Nonrandomized On-Treatment Comparison With His Bundle Pacing and Biventricular Pacing. Can J Cardiol. 2021 Feb;37(2):319-328. doi: 10.1016/j.cjca.2020.04.037. Epub 2020 May 7.

    PubMed 32387225

  • Pujol-Lopez M, Jimenez-Arjona R, Garre P, Guasch E, Borras R, Doltra A, Ferro E, Garcia-Ribas C, Niebla M, Carro E, Puente JL, Vazquez-Calvo S, Invers-Rubio E, Roca-Luque I, Castel MA, Arbelo E, Sitges M, Brugada J, Tolosana JM, Mont L. Conduction System Pacing vs Biventricular Pacing in Heart Failure and Wide QRS Patients: LEVEL-AT Trial. JACC Clin Electrophysiol. 2022 Nov;8(11):1431-1445. doi: 10.1016/j.jacep.2022.08.001. Epub 2022 Oct 26.

    PubMed 36424012

  • Vijayaraman P, Herweg B, Verma A, Sharma PS, Batul SA, Ponnusamy SS, Schaller RD, Cano O, Molina-Lerma M, Curila K, Huybrechts W, Wilson DR, Rademakers LM, Sreekumar P, Upadhyay G, Vernooy K, Subzposh FA, Huang W, Jastrzebski M, Ellenbogen KA. Rescue left bundle branch area pacing in coronary venous lead failure or nonresponse to biventricular pacing: Results from International LBBAP Collaborative Study Group. Heart Rhythm. 2022 Aug;19(8):1272-1280. doi: 10.1016/j.hrthm.2022.04.024. Epub 2022 Apr 30.

    PubMed 35504539

  • Mair H, Sachweh J, Meuris B, Nollert G, Schmoeckel M, Schuetz A, Reichart B, Daebritz S. Surgical epicardial left ventricular lead versus coronary sinus lead placement in biventricular pacing. Eur J Cardiothorac Surg. 2005 Feb;27(2):235-42. doi: 10.1016/j.ejcts.2004.09.029.

    PubMed 15691676

Questions about this trial

What is this clinical trial studying?

An observational study of Heart Failure With Reduced Ejection Fraction, run by Kansas City Heart Rhythm Research Foundation at 1 site in United States.

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 3 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: looking for participants now, as of the sponsor's last update on 28 Oct 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. 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?

This study is still under way. Results are not available in the source record yet.

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

Contact Donita Atkins (816-651-1969, datkins@kchrf.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Need for lead revision (time frame: Procedure Day). 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 NCT06342492, which also lists 15 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 28 Oct 2024; AzTrials last refreshed its copy on 3 Nov 2026.

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