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LBBAP vs. CS Pacing for CRT in Permanent Atrial Fibrillation and Heart Failure (SYNC-AF) (SYNC-AF)

23. April 2026 aktualisiert von: Yonsei University

Left Bundle Branch Area Pacing Versus Coronary Sinus Pacing for Cardiac Resynchronization Therapy for Patients With Permanent Atrial Fibrillation and Heart Failure: The SYNC-AF Trial

This is a prospective, multicenter, randomized controlled trial comparing Left Bundle Branch Area Pacing (LBBAP)-based cardiac resynchronization therapy (CRT) with conventional coronary sinus (CS) lead-based CRT in patients with permanent atrial fibrillation (AF) and heart failure (HF) who meet indications for CRT device implantation.

Atrial fibrillation and heart failure frequently coexist, and both rapid heart rate and its irregularity contribute to worsening cardiac function. Atrioventricular junction (AVJ) ablation combined with CRT (biventricular pacing) has been established as an effective strategy for rate control and cardiac resynchronization in this population, supported by Class I recommendation in the 2021 ESC guidelines. However, conventional biventricular CRT via the CS lead can induce artificial electrical dyssynchrony, particularly in patients with a narrow QRS complex, potentially limiting its benefit.

Conduction system pacing (CSP), including LBBAP, has emerged as a physiologic alternative that directly stimulates the native conduction system, preserving synchronous ventricular activation. Recent evidence (ALTERNATIVE-AF trial) suggests CSP may be superior to biventricular CRT in permanent AF patients undergoing AVJ ablation. However, no randomized controlled trial has directly compared LBBAP-based CRT with CS lead-based CRT in this specific population.

The SYNC-AF trial will randomize 44 patients (22 per arm) to either LBBAP or CS pacing for CRT. The primary endpoint is change in left ventricular ejection fraction (LVEF) at 12 months as assessed by echocardiography in a blinded core laboratory. Secondary endpoints include changes in QRS duration, major adverse clinical events, device/procedure-related complications, and ventricular arrhythmia burden.

Studienübersicht

Status

Noch keine Rekrutierung

Bedingungen

Intervention / Behandlung

Detaillierte Beschreibung

ECHOCARDIOGRAPHIC CORE LAB:

All echocardiographic assessments (LVEF, LVESV, LVEDV, etc.) are performed and interpreted by a blinded independent core laboratory at Severance Hospital to ensure objective and consistent measurement.

FOLLOW-UP SCHEDULE:

Screening (implant day) → Visit 1 (2 weeks-1 month) → Visit 2 (3 months ±3 months) → Visit 3 (6 months ±3 months) → Visit 4 (12 months ±3 months).

STATISTICAL ANALYSIS:

Primary analysis follows the Intention-To-Treat (ITT) principle. Per-Protocol (PP) analysis will be performed as sensitivity analysis. The primary endpoint (LVEF change at 12 months) will be compared using Student's t-test or Wilcoxon rank-sum test. Time-to-event analyses will use Kaplan-Meier survival curves with log-rank test and Cox proportional hazards model.

SAMPLE SIZE:

44 patients total (22 per arm). Based on the assumption of an absolute 10% greater improvement in LVEF with LBBAP-CRT vs. BiV-CRT, with 80% power and 5% two-sided alpha, with 10% dropout allowance.

PARTICIPATING CENTERS:

Multiple centers in the Republic of Korea (at least 4 centers), led by Severance Hospital, Yonsei University College of Medicine.

Studientyp

Interventionell

Einschreibung (Geschätzt)

44

Phase

  • Unzutreffend

Kontakte und Standorte

Dieser Abschnitt enthält die Kontaktdaten derjenigen, die die Studie durchführen, und Informationen darüber, wo diese Studie durchgeführt wird.

Studienkontakt

Teilnahmekriterien

Forscher suchen nach Personen, die einer bestimmten Beschreibung entsprechen, die als Auswahlkriterien bezeichnet werden. Einige Beispiele für diese Kriterien sind der allgemeine Gesundheitszustand einer Person oder frühere Behandlungen.

Zulassungskriterien

Studienberechtigtes Alter

  • Erwachsene
  • Älterer Erwachsener

Akzeptiert gesunde Freiwillige

Nein

Beschreibung

Inclusion Criteria:

  1. Age ≥19 years
  2. Indication for CRT (CRT-P or CRT-D) device implantation per current guidelines
  3. Permanent atrial fibrillation (with or without planned AVJ ablation)
  4. Ability to understand the purpose of the study and provide written informed consent

Exclusion Criteria:

  1. Prosthetic tricuspid valve
  2. Prior myocardial infarction involving the interventricular septal area
  3. Life expectancy less than 12 months
  4. Unable to comply with planned 12-month follow-up for any reason
  5. Pregnancy
  6. History of heart transplantation
  7. Persistent left superior vena cava (PLSVC)

Studienplan

Dieser Abschnitt enthält Einzelheiten zum Studienplan, einschließlich des Studiendesigns und der Messung der Studieninhalte.

Wie ist die Studie aufgebaut?

Designdetails

  • Hauptzweck: Behandlung
  • Zuteilung: Zufällig
  • Interventionsmodell: Parallele Zuordnung
  • Maskierung: Single

Waffen und Interventionen

Teilnehmergruppe / Arm
Intervention / Behandlung
Experimental: LBBAP Group
Participants undergo CRT device implantation (CRT-P or CRT-D) with Left Bundle Branch Area Pacing (LBBAP) as the left ventricular lead strategy. LBBAP is attempted first; if not feasible, crossover to CS lead is permitted. AVJ ablation is performed per clinical indication.
Gerät: Left Bundle Branch Area Pacing (LBBAP) for CRT
CRT device (CRT-P or CRT-D) implantation using LBBAP as the left ventricular pacing lead. A pacing lead is advanced through the interventricular septum to achieve left bundle branch area capture, confirmed by pacing parameters and electrocardiographic criteria (RBBB-like pattern with short R-peak latency in V5/V6). RV lead is implanted in standard fashion. AVJ ablation may be performed per clinical indication.
Aktiver Komparator: CS Pacing Group
Participants undergo CRT device implantation (CRT-P or CRT-D) with conventional Coronary Sinus (CS) lead-based pacing as the left ventricular lead strategy. AVJ ablation is performed per clinical indication.
Gerät: Coronary Sinus (CS) Lead-Based Biventricular CRT
CRT device (CRT-P or CRT-D) implantation using a conventional coronary sinus (CS) lead as the left ventricular pacing lead. The CS lead is advanced via the coronary sinus into a lateral or posterolateral cardiac vein to achieve biventricular pacing. RV lead is implanted in standard fashion. AVJ ablation may be performed per clinical indication.

Was misst die Studie?

Primäre Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
Change from Baseline Left Ventricular Ejection Fraction (LVEF) at 12 Months
Zeitfenster: Baseline (at the time of device implantation) and 12 months post-implantation
Change in left ventricular ejection fraction (LVEF) from baseline to 12 months post-implantation, as measured by transthoracic echocardiography performed and interpreted by a blinded independent central core laboratory. LVEF is assessed using the biplane Simpson method.
Baseline (at the time of device implantation) and 12 months post-implantation

Sekundäre Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
Proportion of patients with absolute LVEF increase ≥5% at 12 months
Zeitfenster: 12 months post-implantation
Echocardiographic CRT response defined as absolute improvement in LVEF of ≥5% or ≥10% from baseline at 12 months, assessed by blinded core lab.
12 months post-implantation
Proportion of patients with absolute LVEF increase ≥10% at 12 months
Zeitfenster: 12 months post-implantation
Echocardiographic CRT response defined as absolute improvement in LVEF of ≥5% or ≥10% from baseline at 12 months, assessed by blinded core lab.
12 months post-implantation
Change in QRS Duration From Baseline
Zeitfenster: Immediately post-implant and at 12 months
QRS duration measured from surface ECG in milliseconds.
Immediately post-implant and at 12 months
Time to First Treated Ventricular Arrhythmia
Zeitfenster: Up to 12 months
Time from randomization to first detection of treated ventricular arrhythmia (VT/VF) recorded by the implanted device within 12 months.
Up to 12 months
Composite of All-Cause Death and Heart Failure Hospitalization
Zeitfenster: Up to 12 months (first occurrence)
Clinical events adjudicated by an independent committee. Heart failure hospitalization defined as unplanned outpatient/ED visit or inpatient admission with HF signs/symptoms requiring intravenous therapy.
Up to 12 months (first occurrence)
All-cause mortality
Zeitfenster: Up to 12 months (first occurrence)
Clinical events adjudicated by an independent committee. Heart failure hospitalization defined as unplanned outpatient/ED visit or inpatient admission with HF signs/symptoms requiring intravenous therapy.
Up to 12 months (first occurrence)
Heart failure hospitalization
Zeitfenster: Up to 12 months (first occurrence)
Clinical events adjudicated by an independent committee. Heart failure hospitalization defined as unplanned outpatient/ED visit or inpatient admission with HF signs/symptoms requiring intravenous therapy.
Up to 12 months (first occurrence)
Cardiovascular death
Zeitfenster: Up to 12 months (first occurrence)
Clinical events adjudicated by an independent committee. Heart failure hospitalization defined as unplanned outpatient/ED visit or inpatient admission with HF signs/symptoms requiring intravenous therapy.
Up to 12 months (first occurrence)
Immediate procedural success rate of LBBAP lead implantation
Zeitfenster: Immediately after the implantation procedure
Successful LBBAP lead placement defined by achievement of left bundle branch capture with acceptable pacing threshold (≤1.5V/0.5ms), impedance (300-1200Ω), and electrocardiographic criteria (RBBB pattern, short R-peak latency in V5/V6).
Immediately after the implantation procedure
Lead capture loss rate at 12 months
Zeitfenster: 12 months post-implantation
Loss of left bundle branch capture or inability to maintain pacing threshold <2.5V/0.5ms at 12 months.
12 months post-implantation
Composite Rate of Worsening Heart Failure by Echocardiographic Criteria
Zeitfenster: Up to 12 months
Composite endpoint defined as ≥5% absolute decrease in LVEF from baseline or ≥15% increase in LVESV from baseline during follow-up.
Up to 12 months
Device and Procedure-Related Complications
Zeitfenster: Up to 12 months (device/procedure-related complications within 7 days for acute; up to 12 months for chronic)
All device/procedure-related complications and reinterventions occurring up to 12 months, adjudicated by an independent events committee.
Up to 12 months (device/procedure-related complications within 7 days for acute; up to 12 months for chronic)
Reintervention Rate
Zeitfenster: Up to 12 months
All device/procedure-related complications and reinterventions occurring up to 12 months, adjudicated by an independent events committee.
Up to 12 months

Mitarbeiter und Ermittler

Hier finden Sie Personen und Organisationen, die an dieser Studie beteiligt sind.

Sponsor

Yonsei University

Studienaufzeichnungsdaten

Diese Daten verfolgen den Fortschritt der Übermittlung von Studienaufzeichnungen und zusammenfassenden Ergebnissen an ClinicalTrials.gov. Studienaufzeichnungen und gemeldete Ergebnisse werden von der National Library of Medicine (NLM) überprüft, um sicherzustellen, dass sie bestimmten Qualitätskontrollstandards entsprechen, bevor sie auf der öffentlichen Website veröffentlicht werden.

Haupttermine studieren

Studienbeginn (Geschätzt)

30. Juni 2026

Primärer Abschluss (Geschätzt)

30. Juni 2029

Studienabschluss (Geschätzt)

31. Dezember 2029

Studienanmeldedaten

Zuerst eingereicht

23. April 2026

Zuerst eingereicht, das die QC-Kriterien erfüllt hat

23. April 2026

Zuerst gepostet (Tatsächlich)

1. Mai 2026

Studienaufzeichnungsaktualisierungen

Letztes Update gepostet (Tatsächlich)

1. Mai 2026

Letztes eingereichtes Update, das die QC-Kriterien erfüllt

23. April 2026

Zuletzt verifiziert

1. April 2026

Mehr Informationen

Begriffe im Zusammenhang mit dieser Studie

Schlüsselwörter

Zusätzliche relevante MeSH-Bedingungen

Andere Studien-ID-Nummern

  • 4-2025-1786

Plan für individuelle Teilnehmerdaten (IPD)

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NEIN

Arzneimittel- und Geräteinformationen, Studienunterlagen

Studiert ein von der US-amerikanischen FDA reguliertes Arzneimittelprodukt

Nein

Studiert ein von der US-amerikanischen FDA reguliertes Geräteprodukt

Nein

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