Physiological Versus Right Ventricular Outcome Trial Evaluated for Bradycardia Treatment Upgrades

NCT ID: NCT06052475

Last Updated: 2024-09-19

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

155 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-09-25

Study Completion Date

2026-08-31

Brief Summary

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Guidelines for patients having first-time implants advocate that even when heart function is only mildly impaired, modern pacing approaches should be utilised to avoid the potentially damaging effects of RV pacing to preventing symptoms from pacing induced or worsened cardiomyopathy.

However, once a traditional (RV) pacemaker is implanted, development of impaired heart function does not prompt a device upgrade. Even at the end of battery life, physicians simply replace it like-for-like.

This trial tests whether such patients have better symptoms and quality of life if changed to a modern physiological pacing strategy from the traditional RV pacing approach.

In this crossover trial, participants will be upgraded to a physiological pacing strategy.

After their procedure, they will have a one-month run-in period to recover from the procedure (their pacemaker will be programmed to continued RV pacing).

They will be have 2 one-month blinded time periods, randomised to physiological pacing or right ventricular pacing alternately. They will subsequently undergo two six-month blinded randomised time periods.

Patients will document symptoms monthly on a mobile phone application or computer. At the end of each time period, they will have measurements of heart function, a walking test and quality-of-life questionnaires including the SF-36 questionnaire.

The investigators hypothesise that upgrading to physiological pacing strategies will improve patients' quality of life.

Detailed Description

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Conditions

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Pacing-Induced Cardiomyopathy Heart Failure

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Physiological Pacing (Conduction System Pacing or Biventricular Pacing)

The approach for physiological pacing will be either His bundle pacing or left bundle pacing at the operator's discretion. If both of these are not achieved biventricular pacing will be performed.

Group Type EXPERIMENTAL

Physiological Pacing Upgrade (Conduction System Pacing or Biventricular Pacing)

Intervention Type DEVICE

The approach for physiological pacing upgrade will be either His bundle pacing or left bundle pacing at the operator's discretion. If both of these are not achieved biventricular pacing will be performed.

Right Ventricular Pacing

Right ventricular pacing (apical or septal lead locations as per the implanting physicians' normal practice)

Group Type ACTIVE_COMPARATOR

Continued RV Pacing (Right Ventricular Pacing)

Intervention Type DEVICE

Right ventricular pacing (apical or septal lead locations as per the implanting physicians' normal practice).

Interventions

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Physiological Pacing Upgrade (Conduction System Pacing or Biventricular Pacing)

The approach for physiological pacing upgrade will be either His bundle pacing or left bundle pacing at the operator's discretion. If both of these are not achieved biventricular pacing will be performed.

Intervention Type DEVICE

Continued RV Pacing (Right Ventricular Pacing)

Right ventricular pacing (apical or septal lead locations as per the implanting physicians' normal practice).

Intervention Type DEVICE

Eligibility Criteria

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Exclusion Criteria

* Those unable to provide informed consent
* Patients under age 18
* Pregnant women
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Imperial College London

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Daniel Keene, PhD

Role: PRINCIPAL_INVESTIGATOR

Imperial College London

Nandita Kaza, MRCP

Role: STUDY_DIRECTOR

Imperial College London

Matthew Shun-Shin, PhD

Role: STUDY_DIRECTOR

Imperial College London

Locations

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Royal Papworth Hospital

Cambridge, , United Kingdom

Site Status RECRUITING

St. Richard's Hospital - University Hospitals Sussex

Chichester, , United Kingdom

Site Status RECRUITING

University Hospitals Coventry and Warwickshire NHS Trust,

Coventry, , United Kingdom

Site Status RECRUITING

Croydon University Hospital - Croydon Health Services

Croydon, , United Kingdom

Site Status RECRUITING

Glenfield Hospital

Leicester, , United Kingdom

Site Status RECRUITING

Hammersmith Hospital

London, , United Kingdom

Site Status RECRUITING

King's College Hospital

London, , United Kingdom

Site Status RECRUITING

St Bartholomew's Hospital - Barts Health NHS Trust

London, , United Kingdom

Site Status RECRUITING

Oxford University Hospitals

Oxford, , United Kingdom

Site Status RECRUITING

University Hospitals Southampton

Southampton, , United Kingdom

Site Status RECRUITING

Great Western Hospitals

Swindon, , United Kingdom

Site Status RECRUITING

Worthing Hospital - University Hospitals Sussex

Worthing, , United Kingdom

Site Status RECRUITING

Countries

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United Kingdom

Central Contacts

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Aya Khalil

Role: CONTACT

07749576830

Nandita Kaza, MRCP

Role: CONTACT

07749576830

Facility Contacts

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Sharad Agarwal

Role: primary

Mark Tanner

Role: primary

Michael Michael

Role: primary

Ravi Kamdar

Role: primary

Ibrahim Mokhtar

Role: primary

Daniel Keene, PhD

Role: primary

Paul Scott

Role: primary

Amal Muthumala

Role: primary

Julian Ormerod

Role: primary

John Paisey

Role: primary

Badri Chandrasekaran

Role: primary

Marian Bencat

Role: primary

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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23HH8156

Identifier Type: -

Identifier Source: org_study_id

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