DANISH-CRT - Does Electric Targeted LV Lead Positioning Improve Outcome in Patients With Heart Failure and Prolonged QRS

  • STATUS
    Recruiting
  • End date
    Nov 1, 2024
  • participants needed
    1000
  • sponsor
    Aarhus University Hospital
Updated on 4 March 2022
ejection fraction
heart failure
heart disease
crt-p
cardiac resynchronization therapy

Summary

Heart failure is a leading cause of morbidity and mortality. Cardiac resynchronization therapy (CRT) is a well-established treatment for patients with symptomatic heart failure in spite of optimised medical treatment (OMT), reduced left ventricular pump function with left ventricular ejection fraction (LVEF) 35% and prolonged activation of the ventricles (bundle branch block: BBB). CRT is established by implanting an advanced pacemaker system with three leads in the right atrium, right ventricle, and in the coronary sinus (CS) for pacing the left ventricle (LV), and often is combined with an implantable defibrillator (ICD) function. On average, CRT treatment improves longevity, quality of life and functional class, and reduces heart failure symptoms. Thus, at present, CRT is indicated for heart failure patients on OMT with BBB or chronic right ventricular (RV) pacing.

It is, however, a significant problem that 30-40% of CRT patients do not benefit measurably - showing symptomatic improvement or improved cardiac pump function - from this therapy (socalled non-responders). LV lead placement is one of the major determinants of beneficial effect from CRT.

Observational studies and three randomised trials with small sample sizes indicate that targeted placement of the LV lead towards a late activated segment of the LV may be associated with improved outcome. Based on this literature, some physicians already search for late activation when positioning the LV lead. However, such a strategy was never tested in a controlled trial with a sample size sufficient to investigate important clinical outcomes. Detailed mapping for a late activation may increase operating times and infection risk, result in use of more electrodes and wires, thereby increasing costs, and increase radiation exposure for patient and staff. Placement of the LV lead in late activated areas close to myocardial scar may even result in higher risk of arrhythmia and death.

At present, it is completely unsettled whether targeted positioning of the LV lead to the latest electrically activated area of LV is superior to contemporary standard CRT with regard to improving prognosis for patients with heart failure and BBB.

The present study aims to test whether targeting the placement of the LV lead towards the latest electrically activated segment in the coronary sinus branches improves outcome as compared with standard LV lead implant in a patient population with heart failure and CRT indication.

Details
Condition Heart Failure, Branch Block, Bundle
Treatment Implantation of a Cardiac Resynchronisation Therapy (CRT) pacing device with or without Implanted Cardioverter Defibrillator
Clinical Study IdentifierNCT03280862
SponsorAarhus University Hospital
Last Modified on4 March 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

Heart Failure, NYHA II, III, outpatient IV
LVEF 35% measured by echocardiography
Optimal medical treatment for heart failure
Bundle Branch Block
Indication for primary CRT-D or CRT-P implantation or upgrade from RV pacing (pacemaker or ICD) to CRT-D or CRT-P
Ischemic heart disease (IHD) or non-IHD
Sinus rhythm or atrial fibrillation
Life expectancy >2 years
Signed informed consent

Exclusion Criteria

NYHA class I
Acute mycardial infarction (AMI) within the latest 3 months
Coronary artery bypass graft (CABG) within the latest 3 months
Life expectancy <2 years
Participation in another clinical trial of experimental treatment
Contraindication for establishing implantable device treatment
Previously implanted CRT system
Does not wish to participate
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