Left Bundle Branch Area Pacing After Transcatheter Aortic Valve Implantation. A Single Center Experience.

BACKGROUND

Permanent pacing after transcatheter aortic valve implantation (TAVI) causes higher rates of death, heart failure (HF) hospitalization and decline in left ventricular ejection fraction (LVEF). Left bundle branch area pacing (LBBAP) may mitigate these adverse events, although experience is limited yet.

OBJECTIVE

To describe the feasibility, safety and clinical outcomes of LBBAP after TAVI during the first year of follow-up.

METHODS

Single-center, retrospective observational study of patients who underwent LBBAP after TAVI between January 2020 and December 2023. Indication for permanent pacing, procedural details, LVEF and NTproBNP were assessed at implantation. Changes in electrophysiological parameters, LVEF, NtproBNP and adverse clinical events were evaluated at 1 year follow-up.

RESULTS

A total of 49 patients underwent LBBAP after TAVI, primarily due to pathologycal eletrophysiological study (44.9%) or complete/high degree atrioventricular block (42.9%). LBBAP reduced QRS duration post-TAVI (147.1 ± 26.4 ms vs. 119.6 ± 12.6 ms, p < 0.001). Acute complications occurred in 10.2% of patients, resolving during hospitalization. During follow-up (15.6 ± 7.0 months), improvement in capture threshold and reduction in ventricular lead impedance were observed. NTproBNP levels decreased significantly, while LVEF remained stable (61.8% [52.0-67.2] vs. 59.0% [51.0-66.0], p = 0.357). Notably, the six patients with baseline LVEF < 40% showed significant LVEF improvement. A total of 12.2% of patients were hospitalized for HF and 12.2% died (half of them due to cardiovascular causes). Multivariate analysis identified atrial fibrillation as the sole predictor of adverse outcomes.

CONCLUSIONS

LBBAP post-TAVI is a feasible and safe pacing strategy, demonstrating favorable electrophysiological and clinical outcomes over 1-year follow-up.