Long-term outcomes of TAVI patients undergoing different pacing modality: LBBAP versus RVP

Abstract

BackgroundNew-onset permanent pacemaker implantation (PPMI) is still a common complication after transcatheter aortic valve implantation (TAVI), leading to adverse clinical outcomes. This study aims to compare the long-term clinical results between traditional right ventricular pacing (RVP) and left bundle branch area pacing (LBBAP) in a large cohort of patients requiring PPMI following TAVI.MethodsA total of 237 consecutive patients undergoing RVP (N=117) or LBBAP (N=120) following TAVI from April 2014 to May 2021 at 3 centers were included. The primary outcome was the composite of all-cause death or heart failure rehospitalization (HFH). Secondary outcomes included all-cause death, HFH and left ventricular ejection fraction (LVEF) change compared to baseline.ResultsThe mean age of the overall population was 74 years with a mean surgical risk score as 4.4%. The paced QRS duration was significantly shorter in LBBAP group compared to RVP group (151 ± 18 vs. 122 ±12 ms, P<0.001). There was a more marked evolution of LVEF over time in LBBAP group (mean LVEF at baseline/follow-up: RVP group: 56/59%; LBBAP group: 57/63%; P=0.046 for LVEF changes over time between groups). There was no remarkable difference between two groups in the primary outcome (29.9% vs. 19.2%, adjusted HR: 1.22; 95% CI: 0.70 to 2.13; P=0.476), however, the risk of HFH was significantly reduced in LBBAP group compared to RVP at 5 years after TAVI (21.4% vs. 7.5%, adjusted HR: 2.26; 95% CI: 1.01 to 5.08; P=0.048).ConclusionsLBBAP improved long-term clinical outcomes compared to RVP in patients undergoing PPMI after TAVI.Graphic abstractLong-term outcomes of LBBAP compared to RVP in TAVI patients.LBBAP is a feasible physiologic pacing modality for TAVI patients in need of permanent pacemaker, resulting in a narrow paced QRS duration. LBBAP was associated with more LVEF improvement compared to traditional RVP in TAVI patients at long-term follow-up, while the risk of death or HFH was not significantly different between two groups. HFH, heart failure rehospitalization; LBBAP, left bundle branch area pacing; LVEF, left ventricular ejection function; RVP, right ventricular pacing; TAVI, transcatheter aortic valve implantation.What is knownNew-onset permanent pacemaker implantation is still a common complication after transcatheter aortic valve implantation (TAVI). Conventional right ventricular pacing (RVP) results in adverse clinical outcomes in TAVI patients.What the study addsLeft bundle branch area pacing (LBBAP) is a feasible and effective physiologic pacing modality for TAVI patients in need of permanent pacemaker. LBBAP improves long-term clinical outcomes compared to RVP in TAVI patients.