Medical device: Only CE-marked CRT-P or CRT-D Medtronic devices locally approved and
commercially available (Medtronic 3830 Pacing Lead) shall be used in this protocol.
Indication: Pacing and sensing in the right atrium or ventricle. It is also designed for
pacing and sensing in the bundle as an alternative to pacing in the right ventricle in a
single or dual chamber pacing system.
Intended use: Patients with an indication for cardiac resynchronization therapy.
Duration of the study: Approximate inclusion period of 18 months
Follow-up: Patients will be followed for 12 months ± 4 weeks after implant
Planned study period: The study is planned to start in Q1 2022
No. of sites: Approximately 11 sites in Spain.
No. of subjects: 176 patients will be enrolled in the study
Study type: Post-market study
Study rationale: Previous studies show 85% implantation success, significant reduction in QRS
duration, and significant improvement in NYHA functional class, LVEF, and LV end-diastolic
diameter. Left bundle branch pacing could be an alternative to conventional biventricular
pacing.
Study design: Multicenter, prospective, randomized, non-inferiority, open.
Objectives of the study:
Primary objective: The primary objective of the study is to demonstrate that LBBAP is
associated with a non-inferior percentage of CRT responders at 6 months follow-up than
conventional BiV pacing using a conventional CS lead in patients with CRT indications
according to current guidelines. Positive CRT response will be defined either by an
improved Clinical Composite Score or ≥15% reduction in left ventricular end-systolic
volume at 6 months follow-up
Secondary objectives: To evaluate reverse ventricular remodeling response and
dyssynchrony parameters based on echocardiographic data at 6 and 12 months follow-up. To
asess clinical outcome using the Clinical Composite Score, 6 minute walking test,
quality of life measurements (EuroQuol EQ 5-D) at 6 and 12 months follow-up. To evaluate
HF related hospitalizations at 6 and 12 months follow-up. To evaluate mortality (global
and cardiovascular) and need for cardiac transplantation at 6 and 12 month follow-up. To
evaluate incidence of ventricular arrhythmias at 6 and 12 month follow-up. To evaluate
differences in CRT response depending on the final LBBAP modality (LBBP vs deep septal
pacing). To evaluate device related complications at 6 and 12 month follow-up.
Primary Outcome Measures: Improved Clinical Composite Score or ≥15% reduction in left
ventricular end-systolic volume at 6 months follow-up.
Participating sites:
Hospital Universitario y Politécnico La Fe, Valencia
Hospital Clinic de Barcelona
Hospital Virgen de las Nieves, Granada
Hospital Virgen de la Arrixaca, Murcia
Hospital Puerta de Hierro, Madrid
Hospital General de Alicante
Hospital Bellvitge, Barcelona
Hospital 12 de Octubre, Madrid
Hospital Universitario Lozano Blesa, Zaragoza
Hospital Juan Ramón Jiménez, Huelva
Hospital Universitario San Cecilio, Granada
Study population: Subjects 18 years of age or older will be included in the study. Both sexes
are eligible to participate. Subjects must present a left bundle branch block (according to
Strauss criteria) with indication of CRT class I or IIa according to clinical practice
guidelines. A selection of the subjects will be made before inclusion following the selection
clinical investigation plan. After confirming that the subject meets the inclusion criteria
and does not meet the exclusion criteria, they will be included in the clinical study.
Study population criteria:
Inclusion criteria: age > 18 years; Class I or IIa indication for CRT according to
current ESC or ACC/AHA/HRS guidelines; left bundle branch block according to Strauss
criteria; Signed and dated informed consent.
Exclusion criteria: Pregnant woman; Permanent or long-lasting atrial fibrillation;
Previous CRT device; Previous PM/ICD with ventricular pacing > 10%; Conventional
pacemaker indication; Nonspecific IVCD (intraventricular conduction delay); Unstable
angina, acute Myocardial Infarction (MI), Coronary Artery Bypass Graft (CABG),
Percutaneous Coronary Angioplasty (PCI), valve repair or replacement within 90 days
prior enrollment; Indication for valve repair or replacement; Already included in
another clinical study that could confoud the results of the present study; Life
expectancy < 12 months.
Device Implantation Procedure: CRT obtained by biventricular pacing vs. CRT obtained by
stimulating the left branch area.
Follow-up: Follow-up should be carried out with pre-established periodic clinical
appointments 3, 6, and 12 months after hospital discharge. In the follow-up, routine
examinations such as vital signs, electrocardiogram and echocardiogram (6 and 12 months) are
recorded to check the evaluation of the reverse ventricular remodeling response and
asynchrony parameters based on echocardiographic data.
Statistical considerations: Once patients have signed the informed consent at baseline visit,
patients will be considered as "Enrolled population" in the statistical analysis. The sample
size is based on the primary endpoint: Improved Clinical Composite Score or ≥15% reduction in
left ventricular end-systolic volume at 6 months follow-up, showing that LBBAP is
non-inferior to BiV-CRT. Accounting for a global attrition rate of 10% and considering the
block size for randomization, 176 patients shall be enrolled.