Long-term outcomes of left bundle branch area pacing compared with right ventricular pacing in TAVI patients

IF 5.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Heart rhythm Pub Date : 2025-07-01 DOI:10.1016/j.hrthm.2024.09.021

Xi Wang MD , Yuanning Xu MD, FHRS , Lijun Zeng MD , Kun Tan MPH , Xueli Zhang MPH , Xu Han MPH , Tianyuan Xiong MD , Zhengang Zhao MD , Yong Peng MD , Jiafu Wei MD , Qiao Li MD , Sen He MD , Yong Chen MD , Minggang Zhou MD , Xi Li MD , Xin Wei MD , Yujia Liang MD , Wenxia Zhou MD , Lingyun Jiang MD , Xingbin Liu MD, FHRS , Mao Chen MD, PhD

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Abstract

Background

New-onset permanent pacemaker implantation (PPMI) is still a common complication after transcatheter aortic valve implantation (TAVI) with adverse clinical outcomes.

Objective

The purpose of this study was to investigate whether left bundle branch area pacing (LBBAP) improves long-term clinical results compared with traditional right ventricular pacing (RVP) in patients requiring PPMI after TAVI.

Methods

A total of 237 consecutive patients undergoing RVP (N = 117) or LBBAP (N = 120) after TAVI were retrospectively included. Long-term outcomes, including all-cause death, heart failure rehospitalization (HFH), and left ventricular ejection fraction (LVEF) change compared to baseline, were obtained until 5 years post-TAVI.

Results

The mean age of the overall population was 74 years, with a mean surgical risk score of 4.4%. The paced QRS duration was significantly longer in the RVP group compared with the LBBAP group (151 ± 18 vs 122 ± 12 ms; P < .001). No difference was found between the 2 groups in all-cause death (13.7% vs 13.3%; adjusted hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.37–1.58; P = .466) or the composite endpoint of death and HFH (29.9% vs 19.2%; adjusted HR, 1.22; 95% CI, 0.70–2.13; P = .476); however, the risk of HFH was significantly higher in the RVP group at 5 years after TAVI (21.4% vs 7.5%; adjusted HR, 2.26; 95% CI, 1.01–5.08; P = .048). There was greater improvement of LVEF over time in the LBBAP group (P = .046 for LVEF changes over time between groups).

Conclusions

LBBAP improved long-term clinical outcomes compared with RVP in patients undergoing PPMI after TAVI in terms of less HFH and better LVEF improvement.

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TAVI 患者左束支区起搏与右心室起搏的长期疗效比较。

背景：新发永久性起搏器植入术（PPMI）仍是经导管主动脉瓣植入术（TAVI）后的常见并发症，会带来不良的临床结果：与传统的右室起搏（RVP）相比，左束支区起搏（LBBAP）是否能改善TAVI术后需要PPMI患者的长期临床效果：回顾性纳入了237例在TAVI术后接受RVP（117例）或LBBAP（120例）治疗的连续患者。研究结果显示，TAVI术后5年前的长期结果包括全因死亡、心衰再住院（HFH）和左室射血分数（LVEF）与基线相比的变化：所有患者的平均年龄为74岁，平均手术风险评分为4.4%。与LBBAP组相比，RVP组的起搏QRS持续时间明显更长（151 ± 18 vs. 122 ± 12 ms）：与RVP相比，LBBAP可改善TAVI术后PPMI患者的长期临床预后，减少HFH，改善LVEF。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.