Heart Failure, Left Bundle-Branch Block
Conditions
Brief summary
This is a prospective, single-arm, non-randomized, non-blinded study designed to characterize the locations of His Bundle (HB) pacing that results in correction of electrical dyssynchrony and to characterize morphology and activation time of local intracardiac electrogram (IEGM) with an electro-anatomical mapping system during a device implant procedure and secondarily to assess the efficacy of HB pacing or HB plus LV pacing (when indicated) in correction of electrical dyssynchrony in heart failure patients with left bundle branch block.
Interventions
PROCEDUREMapping and Pacing the His Bundle
During the device implant procedure, 3D electro-anatomical mapping of the His Bundle region will be performed using EnSite™ Precision™ mapping system and Advisor™ HD Grid mapping catheter. This procedure might be part of the standard-of-care at the participating centers.
PROCEDUREPlacing a guidewire in Coronary sinus for measurement of Q-LV during His Bundle pacing or, if needed, for LV pacing
During the device implant procedure, a VisionWire coronary guidewire will also be placed into a branch of coronary sinus (CS), targeting a lateral branch. This guidewire could be used for collecting local left ventricle (LV) activation time (Q-LV) or pacing the LV. This guidewire could also be used to deliver a LV lead at physician's discretion. This procedure might be part of the standard-of-care at the participating centers.
Sponsors
Abbott Medical Devices
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Patients are undergoing implant of an Abbott pacemaker or CRT device under standard indications 2. An ECG with a wide QRS complex (\>130 ms) 3. ECG morphology of typical complete LBBB, 4. Patients have heart failure with NYHA Class II-IV symptoms, 5. LV EF \<50% 6. At least 18 years old and not pregnant. 7. Must provide written informed consent prior to any clinical investigation related procedure. 8. Willing to comply with study evaluation requirements 9. Female subjects of child-bearing potential are required to have a negative pregnancy test done within 7 days prior to the implant procedure per site standard test. Female patients of childbearing potential should be instructed to use safe contraception (e.g., intrauterine devices, hormonal contraceptives: contraceptive pills, implants, transdermal patches hormonal vaginal devices, injections with prolonged release.)
Exclusion criteria
1. Patients have non-specific intraventricular conduction delay or right bundle branch block 2. Previously implanted cardiac devices with three or more permanent leads 3. History of aortic valve repair or replacement 4. History of tricuspid valve replacement 5. Pregnant or nursing subjects and those who plan pregnancy during the clinical investigation follow-up period. 6. Recent (\< 3 months) myocardial infarction, ablation, electrolyte imbalance, or any condition within the last 90 days that would contraindicate for pacemaker or CRT implant in the opinion of the investigator 7. Presence of other anatomic or comorbid conditions, or other medical, social, or psychological conditions that, in the investigator's opinion, could limit the subject's ability to participate in the clinical investigation or to comply with follow-up requirements, or impact the scientific soundness of the clinical investigation results.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Successful HB pacing sites | At device implant procedure | Collect 3D Locations and electrogram characteristics (morphology and activation time) at the sites where His Bundle (HB) pacing is associated with left bundle recruitment and corrects electrical dyssynchrony at HB pacing implant procedure. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Ventricular activation during HB pacing | At device implant procedure | Collect ventricular activation times during HB pacing or HB plus LV pacing as compared with intrinsic rhythm and other pacing configurations at implant procedure; |
| Echocardiographic measurements of LV ejection fraction | At three-month follow-up | Collect echo measurements of LV ejection fraction at three-month follow-up visit |
| Echocardiographic measurements of LV end-systolic volume | At three-month follow-up | Collect echo measurements of LV end-systolic volume at three-month follow-up visit |
| Success rate of HB pacing | At device implant procedure | Measure success rate of HB pacing or HB plus Left ventricular (LV) pacing in the correction of electrical dyssynchrony at implant procedure; |
| Lead impedance of HB pacing lead | Implant procedure, up to 3 days after implant procedure, two-week follow-up visit, three-month follow-up visit | Measure lead impedance in ohms of HB pacing lead at implant and at follow-up visits post implant |
| Sensing amplitude of HB pacing lead | Implant procedure, up to 3 days after implant procedure, two-week follow-up visit, three-month follow-up visit | Measure sensing amplitude in millivolts of HB pacing lead at implant and at follow-up visits post implant |
| Capture threshold of HB pacing | Implant procedure, up to 3 days after implant procedure, two-week follow-up visit, three-month follow-up visit | Measure capture threshold in volts of HB pacing at implant and at follow-up visits post implant |
Countries
United States
Outcome results
None listed