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Difficulty in enrollment
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In this study, the investigators will examine whether left ventricular pacing is superior to right ventricular apical pacing in preventing deterioration of left ventricular systolic function and cardiac remodeling in patients with bradycardia with high risk for development of pacing-induced heart failure.
In this prospective, we will randomly assign 98 patients who need permanent pacemaker due to complete atrioventricular block or sick sinus syndrome to receive left ventricular pacing (49 patients) or right ventricular apical pacing (49 patients). Patients will be paced with temporary pacemaker lead, and only those with paced QRS duration ≥185 ms will be enrolled.
The primary endpoint is left ventricular ejection fraction measured by modified Simpson method at 12 months. The secondary end points include left ventricular systolic end-systolic and diastolic volume, LV strain, NYHA functional class, exercise performance (using treadmill test), quality of life (using SF-36v2), NT-proBNP at 12 months.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Right ventricular pacing | Active Comparator |
| |
| Left ventricular pacing | Experimental |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| LV pacing | Device | The left ventricular lead are positioned preferentially at the posterolateral or lateral venous branches of the coronary sinus. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Left ventricular ejection fraction (%) at 12 months | Measured by modified Simpson's method | 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Left ventricular end-systolic volume (ml) at 12 months | Measured by modified Simpson method | 12 months |
| Left ventricular end-diastolic volume (ml) at 12 months | Measured by modified Simpson method |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Seil Oh, MD, PhD | Seoul National University Hospital | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Seoul National University Bundang Hospital | Seongnam | 464-707 | South Korea | |||
| Seoul National University Hospital |
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| ID | Term |
|---|---|
| D012804 | Sick Sinus Syndrome |
| ID | Term |
|---|---|
| D001146 | Arrhythmia, Sinus |
| D001145 | Arrhythmias, Cardiac |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
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| RV pacing | Device | The right ventricular lead are positioned at the right ventricular apex. |
|
| 12 months |
| NYHA functional class | 12 months |
| Functional capacity | measured by treadmill test | 12 months |
| NT-proBNP | plasma level | 12 months |
| Seoul |
| 110-744 |
| South Korea |
| D006327 |
| Heart Block |
| D000075224 | Cardiac Conduction System Disease |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |