Conduction system pacing in TAVR patients requiring permanent pacemaker implantation.

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Electrophysiology

Background:

• Permanent pacemaker (PPM) implantation is a frequent complication post-transcatheter aortic valve replacement (TAVR), linked to adverse long-term outcomes.
• Conduction system pacing (CSP) presents a potential alternative to traditional right ventricular pacing (RVP) to mitigate these negative effects.

Purpose of the Study:

• To evaluate if CSP is associated with improved clinical outcomes in TAVR patients who require PPM implantation.

Main Methods:

• An observational, multicenter study included patients needing PPM within 30 days post-TAVR.
• Propensity score matching was utilized to create comparable groups for CSP and RVP.
• The primary endpoint was a composite of death and heart failure hospitalization at 1 year; secondary endpoints included echocardiographic and ECG changes.

Main Results:

• After matching, 706 patients (185 CSP, 521 RVP) were analyzed.
• CSP was linked to a significantly lower risk of death or heart failure hospitalization at 1 year versus RVP (10.8% vs. 20.9%; adjusted HR 0.48).
• CSP also demonstrated a shorter QRS duration at 30 days and improved left ventricular ejection fraction (LVEF) at 1 year.

Conclusions:

• Conduction system pacing (CSP) demonstrates superior 1-year clinical outcomes compared to right ventricular pacing (RVP) in TAVR patients requiring PPM.
• Further prospective randomized trials are necessary to validate these findings and optimize patient selection for CSP.