RAFT-TAVR PACE: LBBAP Vs. RVP Post-TAVR in Patients Requiring PPI
NCT ID: NCT06857201
Last Updated: 2025-03-04
Study Results
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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NOT_YET_RECRUITING
NA
430 participants
INTERVENTIONAL
2025-04-01
2028-12-31
Brief Summary
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This study will evaluate whether Left Bundle Branch Area Pacing (LBBAP), a newer and more natural pacing method, is better than the traditional Right Ventricular Pacing (RVP) at improving heart function and patient outcomes.
The study aims to recruit 60 patients across six centers and will focus on the safety, feasibility, and success of LBBAP compared to RVP. Patients will be followed for one year to assess heart function, quality of life, and any complications related to the pacing method.
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Detailed Description
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Background \& Rationale:
TAVR is an established treatment for severe aortic stenosis, but conduction disturbances requiring permanent pacemaker implantation (PPI) remain a common complication, affecting approximately 15-25% of patients post-TAVR. Conventional RVP has been associated with ventricular dyssynchrony, adverse cardiac remodeling, and increased risk of heart failure.
LBBAP is an emerging conduction system pacing technique that may preserve physiological ventricular activation by engaging the His-Purkinje system more effectively. While observational studies suggest LBBAP may improve ventricular function, quality of life, and clinical outcomes compared to RVP, no large-scale RCT has yet validated these benefits in post-TAVR patients requiring PPI.
Study Objectives:
Primary Objective: Assess the feasibility and success rate of LBBAP implantation in post-TAVR patients requiring PPI and determine if LBBAP results in improved outcomes over RVP.
Secondary Objectives: Evaluate the impact of LBBAP versus RVP on:
Left ventricular activation Left ventricular ejection fraction (LVEF) Quality of life (KCCQ, EQ-5D-5L) Heart failure events and adverse clinical outcomes
Study Design:
The Vanguard Phase will enroll 60 patients across six sites over nine months to establish the feasibility, procedural success, and safety of LBBAP. If successful, the study will expand into a full-scale RCT.
Randomization (1:1) occurs after the clinical decision to implant a pacemaker post-TAVR.
Blinding: The study is double-blinded-patients and follow-up clinicians are blinded to pacing allocation. The implanting physician is unblinded for procedural purposes.
Follow-up Duration: 12 months, with scheduled assessments at 3, 6, and 12 months, including pacemaker interrogation, echocardiography, and quality-of-life questionnaires.
Key Endpoints:
Primary Endpoint:
Feasibility of recruitment (60 patients in 9 months) LBBAP implantation success rate \>90%
Secondary Endpoints:
Improvement in left ventricular activation LVEF at 12 months Quality of life (KCCQ, EQ-5D-5L) changes Rates of heart failure hospitalization and adverse events
Safety \& Data Monitoring:
An independent Data and Safety Monitoring Board (DSMB) will oversee patient safety.
Adverse events will be adjudicated by a blinded committee and reported per regulatory guidelines.
Data collection will be managed through a secure REDCap database.
Significance:
This study will generate critical evidence to determine whether LBBAP should be the preferred pacing modality for post-TAVR patients requiring PPI. If proven superior, LBBAP could redefine post-TAVR pacing guidelines, improving patient outcomes and quality of life.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
TRIPLE
Study Groups
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Left Bundle Branch Area Pacing (LBBAP) Group
Participants randomized to receive Left Bundle Branch Area Pacing (LBBAP) after Transcatheter Aortic Valve Replacement (TAVR). This pacing technique aims to preserve physiologic ventricular activation by directly pacing the left bundle branch area.
Left Bundle Branch Area Pacing
LBBAP is performed during permanent pacemaker implantation post-TAVR.
Right Ventricular Pacing (RVP) Group
Participants randomized to receive Right Ventricular Pacing (RVP) after Transcatheter Aortic Valve Replacement (TAVR). This technique is the traditional pacing method, which stimulates the right ventricle to maintain cardiac rhythm.
Right Ventricular Pacing
RVP is performed during permanent pacemaker implantation post-TAVR.
Interventions
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Left Bundle Branch Area Pacing
LBBAP is performed during permanent pacemaker implantation post-TAVR.
Right Ventricular Pacing
RVP is performed during permanent pacemaker implantation post-TAVR.
Eligibility Criteria
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Inclusion Criteria
2. Persistent HDAVB or CHB identified within 30 days of TAVR
● HDAVB is defined as any of the following(9): Second-degree AV block type 2 (Mobitz II) in the presence of a QRS ≥120 msec, or 2:1 AV block in the presence of a QRS ≥120 msec, or ≥2 consecutive P waves at a constant physiologic rate that do not conduct to the ventricles, or transient third-degree AV block, or in the setting of AF a prolonged pause (\>3 s) or a fixed slow (\<50 beats/min) ventricular response rate.
3. Age ≥ 18 years
Exclusion Criteria
2. More than mild para-valvular regurgitation following TAVR
3. Patients with clinical indication for CRT-D or CRT-P
4. Patients with mechanical tricuspid valve
5. Renal failure - eGFR\<15 or on dialysis
6. Un-revascularized coronary artery disease with proximal multi-vascular coronary disease
7. Acute coronary syndrome with 3 months
8. Cardiogenic shock requiring inotropic therapy within 1 week
9. Life-expectancy \< 2 years
10. Anticipating heart transplant within 1 year
11. Pregnant or intending to become pregnant within the study period
12. Participating in another randomized controlled trial
13. Unable or unwilling to provide consent
18 Years
ALL
No
Sponsors
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London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's
OTHER
Responsible Party
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Habib Khan
Dr. Habib Khan, Co-Principal Investigator
Central Contacts
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Other Identifiers
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5143
Identifier Type: -
Identifier Source: org_study_id
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