Clinical Monitoring Strategy Versus Electrophysiology-guided Algorithmic Approach With a New LBBB After TAVI

NCT ID: NCT03303612

Last Updated: 2025-05-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

250 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-10-15

Study Completion Date

2026-12-31

Brief Summary

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The primary hypothesis of the proposed study is that an electrophysiology-based algorithmic approach is superior to standard clinical follow-up with 30-day monitoring in reducing the combined endpoint of syncope, hospitalization, and death in patients in patients with new of left bundle branch block following transcatheter aortic valve implantation (TAVI).

Detailed Description

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The study population consists of pacemaker-free patients that are 18 years or older undergoing a TAVI with new onset left bundle branch block. Patient consent is required.

Patients meeting the inclusion criteria will be randomized in a 1:1 ratio to one of the following two groups:

Group 1: electrophysiology-based algorithmic approach

Group 2: standard clinical follow-up with transcutaneous cardiac monitoring.

Conditions

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Left Bundle-Branch Block Aortic Valve Stenosis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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EP-based approach/pacemaker implant

Subjects will undergo an EP study prior to hospital discharge and will receive a pacemaker implantation if the HV interval is ≥65 msec.

In the case where the electrical slowdown is not confirmed by the electrophysiological study, the participant will not have a pacemaker implantation.

Group Type OTHER

Pacemaker implant

Intervention Type DEVICE

Patient will be in the electrophysiology laboratory. The doctor will freeze the groin area and a medication may be given to help the patient relax. A catheter will be inserted into the groin up to the heart and the heart's electrical system will be recorded.

Compared transcutaneous cardiac monitor

Subjects will undergo a minimum of 72 hour ECG monitoring in hospital and receive transcutaneous monitoring prior to hospital discharge for a duration of 30 days.

Group Type OTHER

Transcutaneous cardiac monitor

Intervention Type DEVICE

Transcutaneous cardiac patches will allow continuous electrocardiographic monitoring for a 30-day period. For the first randomized patients at the Montreal Heart Institute, Icentia was used and then was changed to a m-Health® device which allows continuous cardiac monitoring. The PocketECG from m-Health® is attached to 3 electrodes on the chest and contains a SIM card that transmits to a server located in Burlington, Ontario .The COME-TAVI coordinating center and the associated site will be informed rapidly of any events that occur . These events include:

Ventricular fibrillation; Sustained ventricular tachycardia Any RR interval \>5 sec; Third-degree AV block or Mobitz 2 AV block;

Interventions

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Pacemaker implant

Patient will be in the electrophysiology laboratory. The doctor will freeze the groin area and a medication may be given to help the patient relax. A catheter will be inserted into the groin up to the heart and the heart's electrical system will be recorded.

Intervention Type DEVICE

Transcutaneous cardiac monitor

Transcutaneous cardiac patches will allow continuous electrocardiographic monitoring for a 30-day period. For the first randomized patients at the Montreal Heart Institute, Icentia was used and then was changed to a m-Health® device which allows continuous cardiac monitoring. The PocketECG from m-Health® is attached to 3 electrodes on the chest and contains a SIM card that transmits to a server located in Burlington, Ontario .The COME-TAVI coordinating center and the associated site will be informed rapidly of any events that occur . These events include:

Ventricular fibrillation; Sustained ventricular tachycardia Any RR interval \>5 sec; Third-degree AV block or Mobitz 2 AV block;

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Age ≥18 years
* Informed consent to participate
* Persistent new-onset LBBB after TAVI implantation (i.e. present at day 2)

Exclusion Criteria

* Prior pacemaker or implantable cardioverter-defibrillator
* Pre-existing right bundle branch block (RBBB) or LBBB (i.e., prior to TAVI)
* Class I or IIA indication for PPM implantation according to management guidelines
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Montreal Heart Institute

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Léna Rivard, MD, MSC

Role: PRINCIPAL_INVESTIGATOR

Montreal Heart Institute

Locations

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Mazankowski Alberta Heart Institute

Edmonton, Alberta, Canada

Site Status RECRUITING

New Brunswick Heart Center

Saint John, New Brunswick, Canada

Site Status NOT_YET_RECRUITING

QEII Health Sciences Center

Halifax, Nova Scotia, Canada

Site Status RECRUITING

Hamilton Health Sciences Corporation

Hamilton, Ontario, Canada

Site Status RECRUITING

London Health Sciences Center (LHSC)

London, Ontario, Canada

Site Status RECRUITING

University of Ottawa Heart Institute (UOHI)

Ottawa, Ontario, Canada

Site Status RECRUITING

Montreal Heart Institute

Montreal, Quebec, Canada

Site Status RECRUITING

CIUSSS du Nord de l'Île de Mtl

Montreal, Quebec, Canada

Site Status RECRUITING

Centre hospitalier universitaire de Sherbrooke

Sherbrooke, Quebec, Canada, Canada

Site Status RECRUITING

Centre Hospitalier Universitaire de Nantes

Nantes, Cedex 01, France

Site Status NOT_YET_RECRUITING

Countries

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Canada France

Central Contacts

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Léna Rivard, MD, MSc

Role: CONTACT

514-376-3330 ext. 2120

Caroline Girard, EP Prof.

Role: CONTACT

514-376-3330 ext. 2905

Facility Contacts

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lena Rivard, MD, MSc

Role: primary

514-376-3330 ext. 2120

Caroline Girard

Role: backup

514-376-3330 ext. 4058

References

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Rivard L, Nault I, Krahn AD, Daneault B, Roux JF, Natarajan M, Healey JS, Quadros K, Sandhu RK, Kouz R, Greiss I, Leong-Sit P, Gourraud JB, Ben Ali W, Asgar A, Aguilar M, Bonan R, Cadrin-Tourigny J, Cartier R, Dorval JF, Dubuc M, Durrleman N, Dyrda K, Guerra P, Ibrahim M, Ibrahim R, Macle L, Mondesert B, Moss E, Raymond-Paquin A, Roy D, Tadros R, Thibault B, Talajic M, Nozza A, Guertin MC, Khairy P. Rationale and Design of the Randomized Bayesian Multicenter COME-TAVI Trial in Patients With a New Onset Left Bundle Branch Block. CJC Open. 2023 Jul 13;5(8):611-618. doi: 10.1016/j.cjco.2023.05.009. eCollection 2023 Aug.

Reference Type DERIVED
PMID: 37720184 (View on PubMed)

Other Identifiers

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ICM#2015-1949

Identifier Type: -

Identifier Source: org_study_id

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