RecruitingNot ApplicableNCT05015660

Conduction System Pacing With Left Bundle Branch Pacing as Compared to Standard Right Ventricular Pacing

LEFT Bundle Pacing vs Standard Right Ventricular Pacing for Heart Failure

Sponsor

McGill University Health Centre/Research Institute of the McGill University Health Centre

Enrollment

1,300 participants

Start Date

Sep 1, 2022

Study Type

INTERVENTIONAL

Conditions

Pacemaker DDD Heart Block

Summary

High burden right ventricular (RV) pacing has been shown to increase cardiovascular mortality, incidence of heart failure (HF), worsen left ventricular (LV) function and accelerate the development of atrial fibrillation (AF). High percentage ventricular pacing and wider paced QRS in the setting of normal baseline LV ejection fractions have consistently been shown to be independent risk factors for pacing-induced cardiomyopathy. Left bundle branch pacing (LBBP) has emerged as a potential alternative pacing mechanism that may avoid LV dyssynchrony and pacing-induced LV dysfunction by mimicking native electrical conduction.

Eligibility

Min Age: 18 Years

Inclusion Criteria7

Age ≥ 18 years
Patients with an ejection fraction of \>35%
Patients with an indication for ventricular pacing and high-degree atrioventricular block where the degree of anticipated RV pacing is \>90% including:
Third degree AV block
Symptomatic or asymptomatic second-degree AV block
First degree AV block ≥ 280ms with a narrow QRS, or ≥ 240ms with an intraventricular delay (QRS duration ≥120ms)
Echocardiogram within the last 3 months, with ability to have DICOM images

Exclusion Criteria8

Indication for an implantable cardioverter defibrillator
Presence of a mechanical tricuspid valve
Any prior attempt at implantation of an ICD, CRT, HBP, or LBBP
Lack of capacity to consent
Other serious medical condition with life expectancy of \<2 years
Pregnancy
Patients in whom the conduction system abnormality is expected to be transient or recover over time
Patients with permanent atrial fibrillation