Conduction system pacing in transcatheter aortic valve replacement patients requiring permanent pacemaker...

Permanent pacemaker (PPM) implantation remains a common complication after transcatheter aortic valve replacement (TAVR) and is associated with poorer long-term outcomes. Conduction system pacing (CSP) has emerged as a promising alternative to reduce the negative effects of chronic pacing.

To determine whether CSP is associated with improved outcomes in patients requiring a PPM after TAVR.

This observational multicenter study included consecutive patients requiring PPM implantation within 30 days after TAVR. This population was propensity matched using a logistic regression model. The primary outcome was a composite endpoint including death and heart failure hospitalization at 1-year follow-up. Echocardiographic and electrocardiogram changes over time were secondary endpoints.

After propensity score matching, 706 patients were included: 185 (26.2%) in the CSP group and 521 (73.8%) in the right ventricular pacing (RVP) group. CSP was associated with a significantly lower risk of all-cause death or heart failure-related hospitalization at 1 year compared to RVP (10.8% vs 20.9%; adjusted hazard ratio [HR] [95% confidence interval]: 0.48 [0.30-0.78]; P = .003). This was driven by significant reductions in both all-cause mortality (HR: 0.52 [0.28-0.96]; P = .036) and heart-failure hospitalization (HR: 0.50 [0.25-0.99]; P = .049). In addition, CSP was associated with a significantly shorter QRS duration at 30 days compared with RVP (123± 20 ms vs 160± 16 ms; P < .001), as well as a significant improvement in left ventricular ejection fraction at 1-year follow-up (+2.8 percentage points; P < .001).

In TAVR patients requiring PPM, CSP was associated with improved clinical outcomes at 1-year follow-up compared to RVP. Prospective randomized studies are needed to confirm longer-term benefits and refine patient selection.