Tests heart pacing upgrade in people with pacing-related heart weakness
Compares a physiological pacing upgrade with continued right ventricular pacing in adults with heart failure.
Plain-language title generated from the registry record
Registry title: Physiological Versus Right Ventricular Outcome Trial Evaluated for Bradycardia Treatment Upgrades
Key facts
- Where
- Cambridge, Chichester, Coventry, Croydon, Leicester, London, Oxford, Southampton, Swindon, and Worthing, United KingdomSee the 12 sites
Where in United Kingdom
- Royal Papworth HospitalCambridge, United KingdomTaking people
- St. Richard's Hospital - University Hospitals SussexChichester, United KingdomTaking people
- University Hospitals Coventry and Warwickshire NHS TrustCoventry, United KingdomTaking people
- Croydon University Hospital - Croydon Health ServicesCroydon, United KingdomTaking people
- Glenfield HospitalLeicester, United KingdomTaking people
- Hammersmith HospitalLondon, United KingdomTaking people
- King's College HospitalLondon, United KingdomTaking people
- St Bartholomew's Hospital, Barts Health NHS TrustLondon, United KingdomTaking people
- Oxford University HospitalsOxford, United KingdomTaking people
- University Hospitals SouthamptonSouthampton, United KingdomTaking people
- Great Western HospitalsSwindon, United KingdomTaking people
- Worthing Hospital - University Hospitals SussexWorthing, United KingdomTaking people
Questions to ask the study team
- How often do I need to come in, and for how long each time?
- Are travel costs paid?
- Can I keep my own doctor?
- What happens if I want to stop?
Trial details
- Who runs it
- Imperial College London
- Trial code
- NCT06052475
- Record updated
- 23 June 2026
- Original description
Guidelines for patients having first-time implants advocate that even when heart function is only mildly impaired, modern pacing approaches should be utilised to avoid the potentially damaging effects of RV pacing to preventing symptoms from pacing induced or worsened cardiomyopathy.Read full original descriptionShow less
Physiological Versus Right Ventricular Outcome Trial Evaluated for Bradycardia Treatment Upgrades
Guidelines for patients having first-time implants advocate that even when heart function is only mildly impaired, modern pacing approaches should be utilised to avoid the potentially damaging effects of RV pacing to preventing symptoms from pacing induced or worsened cardiomyopathy.
However, once a traditional (RV) pacemaker is implanted, development of impaired heart function does not prompt a device upgrade. Even at the end of battery life, physicians simply replace it like-for-like.
This trial tests whether such patients have better symptoms and quality of life if changed to a modern physiological pacing strategy from the traditional RV pacing approach.
In this crossover trial, participants will be upgraded to a physiological pacing strategy.
After their procedure, they will have a one-month run-in period to recover from the procedure (their pacemaker will be programmed to continued RV pacing).
They will be have 2 one-month blinded time periods, randomised to physiological pacing or right ventricular pacing alternately. They will subsequently undergo two six-month blinded randomised time periods.
Patients will document symptoms monthly on a mobile phone application or computer. At the end of each time period, they will have measurements of heart function, a walking test and quality-of-life questionnaires including the SF-36 questionnaire.
The investigators hypothesise that upgrading to physiological pacing strategies will improve patients' quality of life.
Exclusion: Patients under age 18; Those unable to provide informed consent; Pregnant women.
Patients with an RV pacemaker and LVEF 35-50% and a high burden of right ventricular pacing (>40%) who are clinically indicated for a cardiac resynchronisation therapy upgrade procedure and:; EF reduced by >5% of increase in LVESV by 10ml since implant; NT-proBNP >250ng/L in sinus rhythm; NT-proBNP > 750 Ng/L if AF; Left atrial volume index > 30ml/m2; Regular loop diuretics prescribed; Decline in daily patient activity by >1 hour per day since implant; Decrease in device measured thoracic impedance; Patient reported decline in functional class or exercise tolerance.