Feasibility of His-bundle pacing in patients with conduction disorders following transcatheter aortic valve
Jan De Pooter1, Anaïs Gauthey2, Simon Calle1
1Heart Center, Gent University Hospital, Ghent, Belgium.
Insights
His bundle pacing (HBP) is a feasible option for TAVR patients needing pacemakers due to left bundle branch block (LBBB). This technique successfully corrected LBBB in most patients, offering a potential solution for conduction disorders after TAVR.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Transcatheter aortic valve replacement (TAVR) frequently leads to conduction disorders requiring permanent pacemaker implantation.
- Left bundle branch block (LBBB) is a common complication post-TAVR, necessitating intervention.
Purpose of the Study:
- To evaluate the feasibility and safety of His bundle pacing (HBP) in patients who underwent TAVR and developed LBBB.
- To assess HBP's efficacy in correcting TAVR-induced LBBB and its long-term stability.
Main Methods:
- A multicenter study involving 16 TAVR patients with LBBB requiring pacemaker implantation.
- HBP was performed using specific Medtronic pacing leads and sheaths.
- Successful LBBB correction was defined by paced QRS morphology, duration (<120 ms), and pacing thresholds (<3.0 V at 1.0 ms).
Main Results:
- His bundle capture was achieved in 81% of patients.
- LBBB correction was successful in 69% of patients, narrowing QRS duration significantly (162 ms to 99-134 ms).
- Pacing thresholds remained stable at 11-month follow-up, with one instance of temporary atrioventricular block during implantation.
Conclusions:
- Permanent His bundle pacing is feasible for most TAVR patients requiring pacemakers.
- HBP demonstrates potential for correcting TAVR-induced LBBB with acceptable and stable pacing thresholds.
Background:
Conduction disorders requiring permanent pacemaker implantation occur frequently after transcatheter aortic valve replacement (TAVR). This multicenter study explored the feasibility and safety of His bundle pacing (HBP) in TAVR patients with a pacemaker indication to correct a TAVR-induced left bundle branch block (LBBB).
Methods:
Patients qualifying for a permanent pacemaker implant after TAVR were planned for HBP implant. HBP was performed using the Select Secure (3830; Medtronic) pacing lead, delivered through a fixed curve or deflectable sheath (C315HIS or C304; Medtronic). Successful HBP was defined as selective or nonselective HBP, irrespective of LBB recruitment. Successful LBBB correction was defined as selective or nonselective HBP resulting in paced QRS morphology similar to pre-TAVR QRS and paced QRS duration (QRSd) less than 120 milliseconds with thresholds less than 3.0 V at 1.0-millisecond pulse width.
Results:
The study enrolled 16 patients requiring a permanent pacemaker after TAVR (age 85 ± 4 years, 31% female, all LBBB; QRSd: 161 ± 14 milliseconds). Capture of the His bundle was achieved in 13 of 16 (81%) patients. HBP with LBBB correction was achieved in 11 of 16 (69%) and QRSd narrowed from 162 ± 14 to 99 ± 13 milliseconds and 134 ± 7 milliseconds during S-HBP and NS-HBP, respectively (P = .005). At implantation, mean threshold for LBBB correction was 1.9 ± 1.1 V at 1.0 millisecond. Thresholds remained stable at 11 ± 4 months follow-up (1.8 ± 0.9 V at 1.0 millisecond, P = .231 for comparison with implant thresholds). During HBP implant, one temporary complete atrioventricular block occurred.
Conclusion:
Permanent HBP is feasible in the majority of patients with TAVR requiring a permanent pacemaker with the potential to correct a TAVR-induced LBBB with acceptable pacing thresholds.
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