Comparing Left Bundle Branch Area vs Right-Ventricular Septal Pacing in High-Degree Conduction Disease After...

Area of Science:

• Cardiology
• Electrophysiology
• Cardiac Pacing

Background:

• Left bundle branch area pacing (LBBAP) offers physiologic intraventricular synchrony.
• Its superiority over right ventricular septal pacing (RVSP) in preserving left-ventricular (LV) systolic function post-transcatheter aortic valve replacement (TAVR) is unproven.
• Patients undergoing TAVR may develop conduction disease requiring pacing.

Purpose of the Study:

• To investigate if LBBAP is superior to RVSP in preserving LV systolic function after TAVR.
• To compare the effects of LBBAP and RVSP on cardiac synchrony and function in this patient population.

Main Methods:

• A multicenter, prospective, double-blinded, randomized crossover study (Left Bundle BRAVE).
• Adults with severe aortic stenosis, normal LV systolic function, and high-grade atrioventricular block post-TAVR were enrolled.
• Participants were randomized to 9 months of RVSP followed by 9 months of LBBAP, or vice versa, using biventricular pacemakers.

Main Results:

• Primary endpoint: change in global longitudinal strain, secondary endpoint: LV ejection fraction.
• Evaluated echocardiographic markers of synchrony and RV performance.
• Assessed functional status, 6-minute walk test, and biomarkers like BNP.

Conclusions:

• The study aims to identify LBBAP as a superior pacing strategy for preventing LV function deterioration post-TAVR.
• Results will inform clinical practice regarding optimal pacing in TAVR patients with conduction disease.