Chronic Right Ventricular Pacing Post-Transcatheter Aortic Valve Replacement Attenuates the Benefit on Left...

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Biomedical Engineering

Background:

• Conduction abnormalities are a significant complication following transcatheter aortic valve implantation (TAVI).
• Chronic right ventricular (RV) pacing is often required for these conduction abnormalities.
• The impact of RV pacing on long-term clinical outcomes post-TAVI requires further investigation.

Purpose of the Study:

• To evaluate the effect of chronic RV pacing on subclinical left ventricular (LV) systolic function post-TAVI.
• To compare LV systolic function between TAVI patients with and without RV pacing using strain analysis.

Main Methods:

• A cohort of 147 patients requiring chronic RV pacing post-TAVI was propensity-matched to 147 control patients without RV pacing.
• Transthoracic echocardiography (TTE) with speckle-tracking strain analysis was performed 9-18 months post-TAVI.
• Key metrics included LV global longitudinal strain, apical strain, and mid-LV strain.

Main Results:

• No significant difference in Left Ventricular Ejection Fraction (LVEF) was observed between groups at follow-up.
• Patients with RV pacing showed significantly worse LV global longitudinal strain (-12.7% vs. -18.8%, p < 0.0001).
• RV pacing was associated with impaired LV apical strain and mid-LV strain compared to the non-pacing group.

Conclusions:

• Chronic RV pacing following TAVI is associated with subclinical LV systolic dysfunction.
• Strain analysis reveals impaired LV function in RV-paced patients, despite similar LVEF.
• These findings highlight the potential long-term cardiac impact of RV pacing post-TAVI.