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

NCT ID: NCT06342492

Last Updated: 2024-10-28

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

Total Enrollment

100 participants

Study Classification

OBSERVATIONAL

Study Start Date

2023-11-07

Study Completion Date

2024-12-31

Brief Summary

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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.

Detailed Description

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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.

Conditions

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Heart Failure With Reduced Ejection Fraction

Study Design

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Observational Model Type

COHORT

Study Time Perspective

RETROSPECTIVE

Study Groups

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Conduction System Pacing

Subjects who had lead placement via conduction system pacing approach

Coronary Sinus Lead Revision

Intervention Type OTHER

Coronary Sinus Lead Revision

Epicardial Lead Placement

Subjects who had lead placement via transthoracic, epicardial approach

Coronary Sinus Lead Revision

Intervention Type OTHER

Coronary Sinus Lead Revision

Interventions

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Coronary Sinus Lead Revision

Coronary Sinus Lead Revision

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* 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

Exclusion Criteria

* 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.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Kansas City Heart Rhythm Research Foundation

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Naga Venkata K. Pothineni

Role: PRINCIPAL_INVESTIGATOR

Kansas City Heart Rhythm Institute

Locations

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Kansas City Heart Rhythm Institute

Overland Park, Kansas, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Donita Atkins

Role: CONTACT

816-651-1969

Facility Contacts

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Donita Atkins

Role: primary

816-651-1969

References

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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.

Reference Type BACKGROUND
PMID: 12063368 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 34495452 (View on PubMed)

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Reference Type BACKGROUND
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Reference Type BACKGROUND
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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.

Reference Type BACKGROUND
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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.

Reference Type BACKGROUND
PMID: 23315159 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 15854930 (View on PubMed)

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Reference Type BACKGROUND
PMID: 33936744 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 34718539 (View on PubMed)

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Reference Type BACKGROUND
PMID: 31633187 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 35621871 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 32387225 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 36424012 (View on PubMed)

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Reference Type BACKGROUND
PMID: 35504539 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 15691676 (View on PubMed)

Other Identifiers

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KCHRRF_CS Lead Failure_0025

Identifier Type: -

Identifier Source: org_study_id

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