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Atrial FibrillationPACE-AFNCT06377046

Accelerated Pacing in Patients Undergoing Pace-and-ablate Strategy With LBBAP: a Randomized Controlled Pilot Trial

A study testing Accelerated pacing in people with Atrial Fibrillation and Permanent Atrial Fibrillation, run by Maastricht University Medical Center.

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 The sponsor has not verified this record for over two years, so it may be out of date.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

The goal of this clinical trial is to determine the effect of accelerated pacing (pacemaker lower rate programmed to 80bpm) compared to pacing at the standard programmed lower rate of 60bpm in symptomatic atrial fibrillation patients undergoing pace-and-ablate strategy with LBBAP. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Accelerated pacing
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
50 participants
Where
No sites listed yet
Study dates
May 2024to May 2026
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

  • Adults > 18 years of age
  • Referred for pace-and-ablate strategy with LBBAP for symptomatic AF
  • Left ventricular ejection fraction ≥ 40%.
  • Willingness to participate, to understand the instructions and fill out the questionnaires, and ability to sign informed consent.

Who cannot join

  • Infiltrative or constrictive cardiomyopathy (cardiac amyloidosis/sarcoidosis/ constrictive pericarditis)
  • Severe Valvular heart disease (more than moderate valvular stenosis or regurgitation, aortic or mitral valve replacement)
  • Patient participating in another interventional clinical trial
  • Recent (< 3 months) Myocardial infarction (MI), Transient Ischemic Attack or Cerebro- Vascular Accident

Trial locations and contacts

No sites are listed yet.

Kevin Vernooy, MD, PhD contact

+31433877095

kevin.vernooy@mumc.nl

About this study

Official title: Accelerated PACing for Improved Quality of lifE in Symptomatic Atrial Fibrillation Patients Undergoing Pace-and-ablate Strategy With Left Bundle Branch Area Pacing: a Randomized Controlled Pilot Trial: PACE-AF

The goal of this clinical trial is to determine the effect of accelerated pacing (pacemaker lower rate programmed to 80bpm) compared to pacing at the standard programmed lower rate of 60bpm in symptomatic atrial fibrillation patients undergoing pace-and-ablate strategy with LBBAP.

The main question it aims to answer is:

Read more
  • To determine the effect of accelerated pacing on health-related quality of life compared to the current standard of care.

Secondary questions it aims to answer are:

  • To study the acute hemodynamic effect of different (accelerated) pacing rates on pulmonary capillary wedge pressure, cardiac output and arterial blood pressure among atrial fibrillation patients undergoing pace-and-ablate strategy.
  • To study the long-term effects (at 6 months) of accelerated pacing compared to the current standard of care among atrial fibrillation patients undergoing pace-and-ablate strategy on:
  • NT pro BNP levels
  • device detected atrial fibrillation burden and daily activity
  • echocardiographic measurements (LVEF, left ventricular ejection fraction; LVEDD, left ventricular end- diastolic diameter; LVESD, left ventricular end-systolic diameter; LAVI left atrial volume index; diastolic parameters; strain
Read the detailed description

Rationale:

Permanent pacemaker implantation combined with atrioventricular node ablation (AVNA) reduces symptoms and improves health-related quality of life (HRQoL) in patients with symptomatic atrial fibrillation (AF). A high percentage of conventional right ventricular pacing increases the risk for pacing-induced cardiomyopathy, a risk which is presumably minimised by a form of conduction system pacing, termed left bundle branch area pacing (LBBAP). LBBAP attempts to recreate the normal physiologic activation of the heart through stimulation of the heart's own natural conduction system, thereby maintaining ventricular synchrony. This strategy may be particularly important in patients with heart failure with preserved ejection fraction (HFpEF), a diagnosis that frequently coexists with AF. The long-term programming of a patient undergoing a "pace-and-ablate strategy" (pacemaker implantation and AVNA), is such that the lower rate of the pacemaker is routinely set to 60 bpm. Previous studies have shown that accelerated pacing (ie. programming the pacemaker to a lower rate of 80bpm) may improve HRQoL in a subset of patients with HFpEF. It is therefore hypothesized that accelerated pacing will improve HRQoL in patients with symptomatic AF undergoing a pace and ablate strategy, when compared to pacing at 60 bpm, which is standard of care.

Objective:

Primary objective: To determine the effect of accelerated pacing (lower programmed rate of 80 bpm) compared to pacing at the standard programmed rate of 60 bpm on HRQoL in symptomatic AF patients undergoing pace-and-ablate strategy with LBBAP.

Secondary objectives:

  • To study, in a subset of participants who give informed consent, the acute hemodynamic effect of accelerated pacing rates on pulmonary capillary wedge pressure (PCWP), cardiac output and arterial blood pressure, among AF patients undergoing a pace-and-ablate strategy with LBBAP.
  • To study the long-term (6 months) effects of accelerated pacing among AF patients undergoing a pace-and-ablate strategy with LBBAP by measuring NT-proBNP levels, device detected AF-burden and daily activity, by evaluating HRQoL questionnaires (SF-36), and by assessing echocardiographic measurements (LVEF, left ventricular ejection fraction; LVEDD, left ventricular end-diastolic diameter; LVESD, left ventricular end-systolic diameter; LAVI left atrial volume index; diastolic parameters; strain) compared to pacing at the standard of care lower rate of 60bpm.
  • To investigate whether participants experience symptoms of accelerated pacing (such as palpitations), based on the Atrial Fibrillation Effect on Quality-of-life (AFEQT) questionnaire, compared to standard of care.

Study design:

Randomized, single center, prospective, single blinded, parallel group, pilot-trial.

Study population:

Patients ≥ 18 years with symptomatic AF undergoing pace-and-ablate strategy.

Intervention:

  • 1:1 randomization to a lower rate of DDDR 80 bpm (intervention) or a lower rate of DDDR 60 bpm (control). Duration of the study is 6 months.

In a subset of participants:

  • Right heart catheterisation and invasive blood pressure measurements will be conducted to evaluate acute hemodynamic effects of different (accelerated) ventricular pacing rates during the standard of care AV node ablation.

Main study parameters/endpoints:

Primary endpoint:

Difference in HRQoL between a lower rate of 80 bpm and a lower rate of 60 bpm, based on the Minnesota Living with Heart Failure Questionnaire (MLHFQ), determined at 6 months follow-up.

Secondary endpoints:

  • The acute hemodynamic effects of (accelerated) pacing at time of AVNA:
  • Pulmonary Capillary Wedge Pressure (PCWP)
  • Cardiac Output (CO)
  • Systemic arterial blood pressure
  • The long-term effect of accelerated pacing on:
  • HRQoL, based on the MLHFQ and SF-36 questionnaires.
  • NT-proBNP levels
  • Device detected AF burden
  • Device detected daily activity comparing accelerated- vs control rate
  • Echocardiographic measurements (LVEF, LVEDD, LVESD, LAVI, LA strain)
  • Symptoms experienced as a result of (accelerated) pacing based on the AFEQT questionnaire
Being tested
Accelerated pacing, Current standard of care
Medical subject headings
Atrial Fibrillation

What participants receive

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

  • Accelerated pacingDevice

    The lower rate of the pacemaker will be programmed to 80 bpm in DDDR mode with mode switch to DDIR mode.

  • Current standard of careDevice

    The lower rate of the pacemaker will be programmed to the current standard of care which is 60 bpm in DDDR mode with mode switch to DDIR mode.

Study groups in NCT06377046
Study groupRoleWhat they receive
Accelerated pacing (lower rate pacemaker 80bpm)ExperimentalPatients in the experimental arm will have their pacemaker programmed to a lower rate of 80bpm.
Receives: Device: Accelerated pacing
Current standard of care (lower rate pacemaker 60bpm)Active comparatorPatients in the control arm will have their pacemaker programmed to a lower rate of 60bpm, which is the current standard of care.
Receives: Device: Current standard of care

What is being measured

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

  1. The effect of accelerated pacing (lower programmed rate of 80 bpm) compared to pacing at the standard programmed rate of 60 bpm on health-related quality of life (HRQoL) in symptomatic AF patients undergoing pace-and-ablate strategy with LBBAP.

    The primary endpoint of this study is the difference in HRQoL, measured with the Minnesota Living with Heart Failure Questionnaire (MLHFQ), between patients programmed to accelerated pacing with a lower rate of 80 bpm (intervention) compared to current standard of care with a lower rate of 60 bpm (control). The score in the MLHFQ can range between 0 to 105, with higher scores indicating more significant impairment in health-related quality of life.

    Measured: 6 months after the AV node ablation

Secondary outcomes (13)
  1. The acute hemodynamic effects of different (accelerated) pacing rates on pulmonary capillary wedge pressure (PCWP).

    The acute effect of various accelerated pacing rates on PCWP measured by a right heart catheterization during the AV node ablation procedure among AF patients undergoing a pace-and-ablate strategy with LBBAP.

    Measured: At the AV node ablation

  2. The acute hemodynamic effects of different (accelerated) pacing rates on cardiac output (CO).

    The acute effect of various accelerated pacing rates on CO measured by a right heart catheterization during the AV node ablation procedure among AF patients undergoing a pace-and-ablate strategy with LBBAP.

    Measured: At the AV node ablation

  3. The acute hemodynamic effects of different (accelerated) pacing rates on arterial blood pressure.

    The acute effect of various accelerated pacing rates on arterial blood pressure measured invasively in the femoral artery during the AV node ablation procedure among AF patients undergoing a pace-and-ablate strategy with LBBAP.

    Measured: At the AV node ablation

  4. The long-term effects of accelerated pacing on health-related quality of life based on the 36-item short form health survey (SF-36) among AF patients undergoing pace-and-ablate strategy.

    The long-term (6 months) effects of accelerated pacing on HRQoL measured by the SF-36 questionnaire.

    Measured: 6 months after the AV node ablation

  5. The long-term effects of accelerated pacing on NTproBNP levels among AF patients undergoing pace-and-ablate strategy.

    The long-term (6 months) effects of accelerated pacing on NTproBNP levels.

    Measured: 6 months after the AV node ablation

  6. The long-term effects of accelerated pacing on device detected AF burden among AF patients undergoing pace-and-ablate strategy.

    The long-term (6 months) effects of accelerated pacing on device detected AF burden.

    Measured: 6 months after the AV node ablation

  7. The long-term effects of accelerated pacing on device detected daily activity among AF patients undergoing pace-and-ablate strategy.

    The long-term (6 months) effects of accelerated pacing on device detected daily activity.

    Measured: 6 months after the AV node ablation

  8. The long-term effects of accelerated pacing on echocardiographic changes among AF patients undergoing pace-and-ablate strategy.

    The long-term (6 months) effects of accelerated pacing on LVEF.

    Measured: 6 months after the AV node ablation

  9. The long-term effects of accelerated pacing on echocardiographic changes among AF patients undergoing pace-and-ablate strategy.

    The long-term (6 months) effects of accelerated pacing on LVEDD.

    Measured: 6 months after the AV node ablation

  10. The long-term effects of accelerated pacing on echocardiographic changes among AF patients undergoing pace-and-ablate strategy.

    The long-term (6 months) effects of accelerated pacing on LVESD.

    Measured: 6 months after the AV node ablation

  11. The long-term effects of accelerated pacing on echocardiographic changes among AF patients undergoing pace-and-ablate strategy.

    The long-term (6 months) effects of accelerated pacing on LAVI.

    Measured: 6 months after the AV node ablation

  12. The long-term effects of accelerated pacing on echocardiographic changes among AF patients undergoing pace-and-ablate strategy.

    The long-term (6 months) effects of accelerated pacing on LA-strain.

    Measured: 6 months after the AV node ablation

  13. Palpitations experienced as a result of (accelerated) pacing.

    Palpitations experienced as a result of (accelerated) pacing based on the AF effect on quality of life (AFEQT) questionnaire. Patients can score between 0 and 100, with a lower score meaning a worse outcome.

    Measured: 6 months after the AV node ablation

Timeline

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

  1. First posted22 Apr 2024
  2. Study startMay 2024 (estimated)
  3. Primary completionNov 2025 (estimated)
  4. Study completionMay 2026 (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
Model description
Randomized, single center, prospective, single blinded, parallel group, pilot-trial.
Masking
Single blind
Who is masked
Participant
Enrolment
50 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06377046
Sponsor's protocol ID
NL86643.068.24
Acronym
PACE-AF
Status last verified
Apr 2024
First submitted
20 Mar 2024
Last updated
22 Apr 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

A study testing Accelerated pacing in people with Atrial Fibrillation and Permanent Atrial Fibrillation, run by Maastricht University Medical Center.

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 4 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 22 Apr 2024. 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 Kevin Vernooy, MD, PhD (+31433877095, kevin.vernooy@mumc.nl), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

The effect of accelerated pacing (lower programmed rate of 80 bpm) compared to pacing at the standard programmed rate of 60 bpm on health-related quality of life (HRQoL) in symptomatic AF patients undergoing pace-and-ablate strategy with LBBAP. (time frame: 6 months after the AV node ablation). 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 22 Apr 2024.

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PACE-AF Clinical Trial NCT06377046 | AzTrials