This is the first randomized controlled trial comparing transesophageal echocardiography + fluoroscopy guided lead implantation vs. standard lead implantation guided by fluoroscopy only. Patients are randomized 1:1 in the two groups and followed up for up to 3 years.
Lead-induced tricuspid regurgitation is a frequent complication after pacemaker- and ICD-implantation that is associated with increased mortality and hospitalizations for heart failure. Transesophageal echocardiography has shown to be a safe and feasible way to guide right ventricular lead placement and was associated with less worsening of tricuspid regurgitation than standard lead implantation in a small study with a retrospective control group. This is the first randomized controlled trial comparing transesophageal echocardiography + fluoroscopy guided lead implantation vs. standard lead implantation guided by fluoroscopy only. Patients are randomized 1:1 in the two groups and followed up for up to 3 years. Echocardiographic grading of the primary endpoint will be performed by a blinded echocardiographer according to current guidelines.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
324
Transesophageal echocardiography guidance of lead implantation targeting a stable lead position in a tricuspid valve commissure (preferentially postero-septal) and an apical ventricular lead position
LMU Klinikum
Munich, Bavaria, Germany
RECRUITINGWorsening of tricuspid regurgitation by at least one grade
Worsening of tricuspid regurgitation by at least one grade on transthoracic echocardiography according to current guidelines
Time frame: Mean follow up of 2 years
Death and cardiovascular death
All cause death and cardiovascular death
Time frame: Mean follow up of 2 years
Heart failure hospitalizations
Unplanned hospitalizations for heart failure
Time frame: Mean follow up of 2 years
Duration of procedure and radiation
Standard parameters affecting quality of device implantation
Time frame: Mean follow up of 2 years
Right ventricular function and geometry as assessed by transthoracic echocardiography
Right ventricular function (TAPSE, fractional area change, 3D volumetry) and geometry as assessed by transthoracic echocardiography
Time frame: Mean follow up of 2 years
Sensing, Pacing and RV-stimulation of the right ventricular lead
Sensing, Pacing and RV-stimulation of the right ventricular lead in the pacemaker readout
Time frame: Mean follow up of 2 years
Change in functional capacity as assessed NYHA classification
New York Heart Association (NYHA) Functional Classification
Time frame: Mean follow up of 2 years
Change in quality of life as assessed by MLHFQ
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Minnesota Living with Heart Failure Questionnaire
Time frame: Mean follow up of 2 years