Left bundle branch area pacing in patients requiring permanent pacemaker implantation after transcatheter aortic...

Conduction disorders such as left bundle branch block (LBBB) and high-grade atrioventricular block are frequent complications following transcatheter aortic valve implantation (TAVI), often requiring permanent pacemaker implantation. Left bundle branch area pacing (LBBAP) is a promising physiological pacing technique, but data on its feasibility post TAVI remain limited.

This study aimed to evaluate the feasibility of LBBAP after TAVI and compare outcomes with patients without prior valvular intervention.

This single-center observational study included 152 patients with indications for permanent pacemaker implantation who underwent LBBAP: 25 after TAVI and 127 without any valvular intervention. The procedural success rate, pacing parameters, and electrocardiographic outcomes were compared. To reduce potential selection bias and ensure better group comparability, propensity score matching was performed. Follow-up was conducted at one-month post implantation.

LBBAP was successful in most cases, with comparable rates in the TAVI and control cohorts (88% vs. 93%; P = 0.42). Confirmed left bundle branch pacing/left fascicular pacing capture was likewise similar (80% vs. 81%; P = 1). Although TAVI patients were older and more often exhibited baseline LBBB (48% vs. 7%; P <0.001), pacing thresholds, R-wave sensing, QRS narrowing, complication rates, and one-month pacing parameters did not differ between groups.

LBBAP is a feasible and safe pacing strategy in patients after TAVI. It preserves physiological ventricular activation and corrects TAVI-induced LBBB. Given its favorable electrical parameters and high procedural success, LBBAP should be considered the preferred pacing modality in patients requiring permanent pacemaker implantation following TAVI.