Left Bundle Branch Area Pacing versus Deep Septal Pacing in Patients After Transcatheter Aortic Valve Replacement

Left bundle branch area pacing (LBBAP) has been reported to improve long-term clinical outcomes in patients requiring permanent pacemaker implantation (PPMI) after transcatheter aortic valve replacement (TAVR). Deep septal pacing (DSP) has emerged as a potential alternative to LBBAP.

This study investigated whether short-term and long-term clinical outcomes differ between LBBAP and DSP in post-TAVR patients.

Consecutive patients undergoing LBBAP or DSP following TAVR were retrospectively included at our institution. Short-term clinical outcomes (1-year follow-up) were assessed by echocardiographic measures of reverse remodeling and changes in QRS duration and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. For long-term outcomes, the primary composite endpoint was all-cause mortality or heart failure hospitalization (HFH). Secondary endpoints included HFH and improvement in New York Heart Association (NYHA) class (≥ 2 grades).

A total of 82 patients (39 LBBAP and 43 DSP) were observed for a mean duration of 731.8 days. There was no significant difference between two groups in the risk of primary endpoint (23.1% vs. 23.3%, adjusted hazard ratio [aHR] 0.61; 95% CI: 0.23-1.61, p = 0.315) and HFH (17.9% vs. 20.9%, aHR 0.64; 95% CI: 0.22-1.82; p = 0.402). However, LBBAP was a robust predictor of NYHA class improvement compared to DSP (53.8% vs. 27.9%, aHR 2.23; 95% CI: 1.03-4.87, p = 0.043), especially when left bundle branch (LBB) capture was independently confirmed (aHR 2.74, p = 0.006). Both modalities were similarly effective in improving electromechanical and biochemical parameters, including LVEF, LVEDD, QRS duration, and NT-proBNP (all p > 0.05).

LBBAP and DSP yield comparable risks for the primary composite endpoint and HFH, yet LBBAP provides superior symptomatic relief. Confirmation of left bundle branch capture is advisable to optimize clinical benefits. Liangzhen Qu and Xueting Duan contributed equally to this manuscript.