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Conduction system pacing in prosthetic heart valves.

Kuldeep Shah1, Brian D Williamson1, Ilana Kutinsky1

  • 1Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA.

Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing
|April 26, 2022
PubMed
Summary

Conduction system pacing (CSP) is a safe and effective technique for patients with prosthetic heart valves. Left bundle branch area pacing (LBBAP) demonstrates higher success rates and better lead parameters compared to His bundle pacing (HBP), particularly after TAVR.

Keywords:
Conduction system pacingLeft bundle branch area pacingProsthetic heart valves

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Pacing

Background:

  • Increasing interest in physiologic pacing techniques activating the specialized conduction system.
  • Assessment of conduction system pacing (CSP) outcomes in patients with prosthetic heart valves.

Approach:

  • Systematic review conducted according to PRISMA guidelines.
  • Utilized Freeman-Tukey double arcsine transformation and random-effect model for data synthesis.
  • Evaluated implant success, lead parameters, and procedure-related complications.

Key Points:

  • Reviewed 7 studies with 267 patients undergoing CSP after prosthetic valve implantation.
  • Overall CSP success rate was 87%, with 83.2% in post-TAVR patients.
  • Left bundle branch area pacing (LBBAP) showed significantly higher success rates (94.3%) than His bundle pacing (HBP) (76.5%), especially in post-TAVR patients (94.3% vs. 66.9%).
  • LBBAP demonstrated significantly lower pacing thresholds at implant and follow-up compared to HBP.

Conclusions:

  • CSP is a safe and feasible pacing option for patients with prosthetic heart valves.
  • LBBAP offers superior success rates and lead parameters compared to HBP in this patient cohort.
  • LBBAP is particularly advantageous for patients who have undergone transcatheter aortic valve replacement (TAVR).