RESynchronisation in Patients With Heart Failure and a Normal QRS Duration

AIMS and Objectives A randomised controlled clinical trial

Primary objective

• Improvements in 6-min walking distance

Secondary objectives Determine

• Symptomatic improvement in quality of life, using the Minnesota Living with Heart Failure questionnaire
• Change in NT pro-BNP and echocardiographic parameters of LV function
• Does MRI Dyssynchrony Index (CMR-TSI) predicts responders.
• Morbidity and Mortality using CARE-HF definitions
• Packer combined clinical composite score

Study Design A pilot randomised controlled clinical trial 60 patients. The biventricular pacemaker with be optimized for both A-V delay and V-V delay.

Subject Selection Source - Patients attending Good Hope Hospital, Sandwell Hospital Centres involved - 2 Eligible Participants - 60 patients with heart failure and narrow QRS.

Inclusion criteria

Sinus rhythm Symptomatic heart failure - NYHA class III or IV ECG QRS duration less than 120 milliseconds LV ejection fraction of less than 35% on echocardiography using Simpsons technique.

Able to give informed consent

Exclusion criteria

Age below 18 Current or planned pregnancy Patient refusal Ventricular tachycardia or ventricular fibrillation Current or recent (within last 30 days) involvement in other studies Requires implantable cardioverter defibrillator (ICD) according to NICE criteria for implantation (England and Wales)

Definition of clinical response:- 20% improvement in 6 minute walk distance or any improvement from 0

Definition of echocardiographic response:- 15% or greater decrease in left ventricular end systolic volume

Follow up 6 weeks and 6 monthly thereafter. Interim results at 6 months. Analysis of results, echocardiograms, MRI and BNP will be blind Walk distance to be measured by unblinded observer and by pedometer.

Randomisation:

Numbered envelopes will be prepared by sponsor (Heart of England NHS Foundation Trust) and kept from researchers. After informed consent, the patient will be enrolled and the technician will draw the result.

This trial was known as the Birmingham biventricular pacing in patients unselected for dyssynchrony (BIPIDS).

Inclusion criteria

• Sinus rhythm
• Symptomatic heart failure - NYHA class III or IV
• ECG QRS duration less than 120 milliseconds
• LV ejection fraction of less than 35% on echo
• Able to give informed consent

Exclusion criteria

• Age below 18
• Current or planned pregnancy
• Patient refusal
• Ventricular tachycardia or ventricular fibrillation
• Current or recent (within last 30 days) involvement in other studies
• Requires implantable cardioverter defibrillator (ICD)