It is hoped that the results from this small-scale study will provide a much needed evidence for changing clinical practice on permanent pacemaker implantation.
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Persistent irregular heart beats are usually caused by a failure in the conduction of electrical signals from the natural pacemakers of the heart. The heart's "natural" pacemaker is called the sinoatrial node or sinus node. The natural pacemaker may be defective, causing the heartbeat to be too fast, too slow or irregular or the hearts' own electrical pathways may also be blocked. An "artificial pacemaker" which is a small, battery-operated device that helps the heart to beat in a regular rhythm can be prescribed. Traditional pacing is via an electrical lead at the tip of the right bottom pumping chamber of the heart or the right ventricular apex (RVA). Although this pacing position maintains regular heart rates and a uniform pumping sequence (synchrony) between the upper and lower pumping chambers of the heart, RVA pacing is associated with increased complications and death as compared to the natural ventricular electrical conduction. This is because RVA pacing initiates abnormal electrical signals that are out of sequence (asynchronous) resulting in abnormal contraction and relaxation of the left bottom pumping chamber (left ventricles) of the heart, increased strain to the wall of the left ventricles, a lack of simultaneous alignment of heart muscle fibres and pumping defects which renders the patient at increased risk of heart failure and death. Other sites such as the wall between the two bottom chambers (inter-ventricular septum) and at the area around the opening of the right ventricles commonly described as the right ventricular outflow tract (RVOT) are being considered as possible better alternatives This will be the first study that investigates the medium to long term effects of RVOT as compared to RVA pacing. It is anticipated that the project will take up to 3 years to demonstrate any impact. 240 echocardiograms (¬£10 per check) ¬£2,400 240 cardiopulmonary exercise tests (¬£10 per test) ¬£2,400 Project management costs over 36 months ¬£64,420 Total Costs ¬£69,220
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