Permanent pacemaker implantation and left bundle branch block with self-expanding valves - a SCOPE 2 subanalysis

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Prosthetic Heart Valves

Background:

• Limited data exist from randomized trials comparing ACURATE neo and CoreValve Evolut devices regarding left bundle branch block (LBBB) and permanent pacemaker implantation (PPI).
• Understanding these complications is crucial for optimizing transcatheter aortic valve replacement (TAVR) outcomes.

Purpose of the Study:

• To assess the incidence and impact of new LBBB and PPI in patients receiving self-expanding prostheses.
• To compare these outcomes between the ACURATE neo and CoreValve Evolut devices within a randomized trial.

Main Methods:

• Analysis of 648 patients from the SCOPE 2 trial for PPI at 30 days.
• Analysis of 426 patients without prior LBBB for LBBB incidence at 30 days.
• Comparison of PPI and LBBB rates between ACURATE neo and CoreValve Evolut groups.

Main Results:

• 16.5% of patients required PPI at 30 days, with higher rates for CoreValve Evolut (21.0%) vs. ACURATE neo (12.3%).
• New LBBB developed in 9.4% of patients, also higher with CoreValve Evolut (13.4%) vs. ACURATE neo (5.5%).
• Previous right bundle branch block increased PPI risk; ACURATE neo use decreased PPI risk.

Conclusions:

• New LBBB and PPI rates were significantly lower with the ACURATE neo compared to the CoreValve Evolut.
• The ACURATE neo demonstrated a reduced risk of PPI at 30 days.
• New LBBB at 30 days was associated with reduced ejection fraction at one year, with no significant impact on one-year mortality from PPI.