Comparison of Valvular and Ventricular Function After Right Ventricular, Leadless, Deep Septal, and Left Bundle Branch Area Pacemakers.

INTRODUCTION: Changes in tricuspid regurgitation (TR), mitral regurgitation (MR), and left ventricular ejection fraction (LVEF) are frequently noted after right ventricular apical (RVA) pacemaker implantation but prior studies evaluating whether left bundle branch area (LBBA), deep septal (DS), or leadless pacemaker implantation modify risk for those changes are limited. This study aims to compare changes in TR, MR, and LVEF after implantation of RVA, LBBA, DS, and leadless pacemakers.

METHODS: Patients were included if they underwent de novo pacemaker implantation for sinus node dysfunction or atrioventricular block and received pre- and post-implant echocardiography. Change in TR, MR, and LVEF were analyzed using post-hoc adjusted Kruskal-Wallis and Chi-squared testing, and multivariable ordinal logistic regression.

RESULTS: Among 386 consecutive patients (RV, n = 185; LBBA, n = 122; DS, n = 43, leadless, n = 36) the change in TR grade differed between pacemaker types (median [interquartile range] grade change: RVA 0[0,1], leadless 0[0,1], DS 0[0,1], LBBA 0[0,0]; p = 0.01). In multivariable ordinal logistic regression, leadless (OR 2.41, p = 0.01) and DS pacemakers (OR 2.44, p < 0.01) predicted TR worsening compared to LBBA. The change in MR grade also differed between pacemaker types (grade change: RVA 0[0,1], leadless 0[0,1], DS 0[0,0], LBBA 0[-1,0]; p = 0.03). The change in LVEF differed between pacemaker types (LVEF change: RVA -3[-9,3]%, leadless -5[-14,1]%, DS -3[-11,0]%, LBBA -1[-5,5]%; p < 0.01).

CONCLUSION: The change in TR and MR grade and LVEF following pacemaker implant varied by pacemaker type. Compared to implantation with RVA, leadless, and DS pacemakers, LBBA pacemaker implantation was associated with more favorable changes in valvular and ventricular function.