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Heart BlockNCT06636851

Effect of Site of Right Ventricular (RV) Pacing on RV Function, Left Ventricular (LV) Dyssynchrony and Contraction Efficiency

A study testing Pacemaker and defibrillator in people with Heart Block and Heart Block Complete, run by South Valley University at 1 site in Egypt.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

To evaluate RV systolic function and LV mechanical dyssynchrony and function in different lead position in the RV during permanent pacemaker implantation by using speckle tracking echocardiography (STE) and 3D volumetric ejection fraction Read more about this study

Who is it for?
Any age
What is being tested?
Pacemaker and defibrillator
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
52 participants
Where
1 siteEgypt
Study dates
15 Aug 2022to 15 Aug 2024
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 Any age
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Patients with symptomatic bradycardia indicated for permanent pacemaker implantation according to recent European guidelines.

Who cannot join

  • Patients with reduced RV function.
  • Patients with reduced LV systolic function.
  • Significant valvular lesions.
  • Congenital heart disease that might affect RV and/or LV function.
  • Patients undergoing CRT or Implantable Cardioverter-Defibrillator (ICD).

Trial locations and contacts

1 site in 1 country.

Egypt1 site
  • South Valley University

    Qena Governorate, Qena Governorate, 83523

Other trials in Egypt

About this study

To evaluate RV systolic function and LV mechanical dyssynchrony and function in different lead position in the RV during permanent pacemaker implantation by using speckle tracking echocardiography (STE) and 3D volumetric ejection fraction

Read the detailed description

Permanent pacing with right ventricular stimulation is the standard method used in patients with bradyarrhythmia, and recommended by current international guidelines because it is associated with improved clinical outcomes. The extent of right ventricular pacing (RVP) varies between patients and many individuals tolerate a high proportion of RVP without complications. However, chronic RVP may cause electrical and mechanical dyssynchrony that may lead to impaired left ventricular ejection fraction (LVEF). Dyssynchronous ventricles require more oxygen to generate the same amount of mechanical work and the consequence is a decline in the efficieny of myocardial contraction. RV septal pacing (RVS) is thought to allow more physiological LV depolarisation, than RV apical pacing (RVA) with preservation of LV function. However, there are conflicting data on its benefits, and the recently completed Protect-Pace (The protection of LV function during RV pacing) study showed both RVA and non-RVA pacing to have a small adverse effect on EF in patients with preserved LV function, but no difference between the methods. The effect of RV pacing on RV function has not been evaluated systematically, with most studies focusing on tricuspid regurgitation (TR) as the outcome of interest. Echocardiographic assessment of LV dyssynchrony has been extensively used because it is noninvasive, widely available, and has no known risk or side effect. Speckle tracking echocardiography is a novel echocardiographic technique without the angle dependence of an ultrasound beam and is able to measure regional deformation in any direction in the LV and RV, that can detect subtle myocardial dysfunction because it is more sensitive compared with conventional parameters, Furthermore, strain imaging can display the timing and extent of myocardial thickening and stretching so that it is well suited to estimate the amount of inefficient dyssynchronous contraction. Global Longitudinal Strain (GLS) and LV mechanical function and dyssynchrony assessment by speckle-tracking echocardiography (STE) enables us to detect subclinical LV dysfunction. And also a very attractive clinical tool for the assessment of right ventricular (RV) systolic performance, providing incremental diagnostic and prognostic information over the traditional indices of RV function, Among various imaging modalities, echocardiography is currently the method of choice for clinical assessment of RV longitudinal strain (RVLS). The methodology of speckle-tracking echocardiography to obtain RVLS has been recently standardized and demonstrated to be feasible, accurate, and robust for clinical use. Inter-technique and inter-vendor comparability and reliability of RVLS are improving. RVLS is advantageous because it is more sensitive to subtle changes in myocardial function than conventional parameters used to assess RV function (i.e. tricuspid annular plane systolic excursion, tissue Doppler systolic velocity, fractional area change, or RV ejection fraction) representing a sensitive tool for the long-term follow-up of patients.

Being tested
Pacemaker and defibrillator
Keywords
pacemaker, RV function, LV function, GLS
Medical subject headings
Heart Block

What participants receive

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

  • Pacemaker and defibrillatorDevice

    Also called Pacemaker lead location to the RV septum

    Permenant pacemaker implantation with lead fixed to the RV Septal location

  • Pacemaker and defibrillatorDevice

    Also called Pacemaker lead location to the RV Apex

    Description: Permenant pacemaker implantation with lead fixed to the RV Apical location

Study groups in NCT06636851
Study groupRoleWhat they receive
RV Apical pacingActive comparatorPatient with the pacemaker RV lead located at the RV apex
Receives: Device: Pacemaker and defibrillator
RV Septal pacingActive comparatorPatient with the pacemaker RV lead located at the RV septum.
Receives: Device: Pacemaker and defibrillator

What is being measured

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

  1. To detect a 3% difference in Longitudinal Strain (GLS) between groups.

    To detect a 3% difference in Longitudinal Strain (GLS) between group A (right ventricular apex) and the group B (right ventricular septum).

    A standard deviation of 4% was used for the sample size calculation based on previous studies

    Measured: 6 months

Timeline

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

  1. First posted15 Oct 2024
  2. Study start15 Aug 2022
  3. Primary completion15 Mar 2024
  4. Study completion15 Aug 2024

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
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Care provider, Outcomes assessor
Enrolment
52 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06636851
Sponsor's protocol ID
RV Pacemaker lead location
Status last verified
Oct 2024
First submitted
11 Sep 2024
Last updated
15 Oct 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Saito M, Iannaccone A, Kaye G, Negishi K, Kosmala W, Marwick TH; PROTECT-PACE investigators. Effect of Right Ventricular Pacing on Right Ventricular Mechanics and Tricuspid Regurgitation in Patients With High-Grade Atrioventricular Block and Sinus Rhythm (from the Protection of Left Ventricular Function During Right Ventricular Pacing Study). Am J Cardiol. 2015 Dec 15;116(12):1875-82. doi: 10.1016/j.amjcard.2015.09.041. Epub 2015 Oct 9.

    PubMed 26517949
  • Michalik J, Dabrowska-Kugacka A, Kosmalska K, Moroz R, Kot A, Lewicka E, Szolkiewicz M. Hemodynamic Effects of Permanent His Bundle Pacing Compared to Right Ventricular Pacing Assessed by Two-Dimensional Speckle-Tracking Echocardiography. Int J Environ Res Public Health. 2021 Nov 8;18(21):11721. doi: 10.3390/ijerph182111721.

    PubMed 34770235
  • Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabes JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylen I, Tolosana JM; ESC Scientific Document Group. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: Developed by the Task Force on cardiac pacing and cardiac resynchronization therapy of the European Society of Cardiology (ESC) With the special contribution of the European Heart Rhythm Association (EHRA). Rev Esp Cardiol (Engl Ed). 2022 May;75(5):430. doi: 10.1016/j.rec.2022.04.004. No abstract available. English, Spanish.

    PubMed 35525571
  • Van De Heyning CM, Elbarasi E, Masiero S, Brambatti M, Ghazal S, Al-Maashani S, Capucci A, Leong D, Shivalkar B, Saenen JB, Miljoen HP, Morillo CA, Divarakarmenon S, Amit G, Ribas S, Baiocco E, Maolo A, Romandini A, Maffei S, Connolly SJ, Healey JS, Dokainish H. Prospective Study of Tricuspid Regurgitation Associated With Permanent Leads After Cardiac Rhythm Device Implantation. Can J Cardiol. 2019 Apr;35(4):389-395. doi: 10.1016/j.cjca.2018.11.014. Epub 2018 Nov 29.

    PubMed 30852048
  • Kaye GC, Linker NJ, Marwick TH, Pollock L, Graham L, Pouliot E, Poloniecki J, Gammage M; Protect-Pace trial investigators. Effect of right ventricular pacing lead site on left ventricular function in patients with high-grade atrioventricular block: results of the Protect-Pace study. Eur Heart J. 2015 Apr 7;36(14):856-62. doi: 10.1093/eurheartj/ehu304. Epub 2014 Sep 4.

    PubMed 25189602
  • Khurshid S, Epstein AE, Verdino RJ, Lin D, Goldberg LR, Marchlinski FE, Frankel DS. Incidence and predictors of right ventricular pacing-induced cardiomyopathy. Heart Rhythm. 2014 Sep;11(9):1619-25. doi: 10.1016/j.hrthm.2014.05.040. Epub 2014 Jun 2.

    PubMed 24893122
  • 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; ESC Committee for Practice Guidelines (CPG); Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S; Document Reviewers; Kirchhof P, Blomstrom-Lundqvist C, Badano LP, Aliyev F, Bansch D, Baumgartner H, Bsata W, Buser P, Charron P, Daubert JC, Dobreanu D, Faerestrand S, Hasdai D, Hoes AW, Le Heuzey JY, Mavrakis H, McDonagh T, Merino JL, Nawar MM, Nielsen JC, Pieske B, Poposka L, Ruschitzka F, Tendera M, Van Gelder IC, Wilson CM. 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). Eur Heart J. 2013 Aug;34(29):2281-329. doi: 10.1093/eurheartj/eht150. Epub 2013 Jun 24. No abstract available.

    PubMed 23801822
  • Candan O, Gecmen C, Bayam E, Guner A, Celik M, Dogan C. Mechanical dispersion and global longitudinal strain by speckle tracking echocardiography: Predictors of appropriate implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy. Echocardiography. 2017 Jun;34(6):835-842. doi: 10.1111/echo.13547. Epub 2017 Apr 26.

    PubMed 28444773
  • Abdin A, Yalin K, Zink MD, Napp A, Gramlich M, Marx N, Schuett K. Incidence and predictors of pacemaker induced cardiomyopathy: A single-center experience. J Electrocardiol. 2019 Nov-Dec;57:31-34. doi: 10.1016/j.jelectrocard.2019.08.016. Epub 2019 Aug 23.

    PubMed 31473477

Questions about this trial

What is this clinical trial studying?

A study testing Pacemaker and defibrillator in people with Heart Block and Heart Block Complete, run by South Valley University at 1 site in Egypt.

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 1 inclusion and 5 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: finished, as of the sponsor's last update on 15 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 Egypt. 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?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

To detect a 3% difference in Longitudinal Strain (GLS) between groups. (time frame: 6 months). 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 NCT06636851, which also lists 9 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 15 Oct 2024.

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