Incidence and predictors of tricuspid regurgitation after left bundle branch area pacing: A Korean multicenter...

Left bundle branch area pacing (LBBAP) is a physiologic pacing strategy encompassing heterogeneous pacing subtypes. However, predictors of clinically significant tricuspid regurgitation (TR) after LBBAP, particularly according to pacing subtype, remain unclear.

To identify the incidence and predictors of significant TR following LBBAP.

We retrospectively analyzed patients from 31 centers who underwent successful LBBAP between 2021 and 2024 and had no or mild TR at baseline. LBBAP was categorized as left bundle branch pacing, left fascicular pacing, and left ventricular septal pacing (LVSP). The primary outcome was incident TR, defined as new-onset moderate-or-greater TR on follow-up echocardiography performed 6-12 months after the index procedure. Multivariable logistic regression was performed to identify predictors of incident TR.

Among 523 patients (mean age, 72.5 ± 11.9 years; 45.5% male), 35 (6.7%) developed incident TR during 1-year follow-up. Compared with patients without incident TR, those with incident TR had a significantly higher prevalence of atrial fibrillation (AF), higher baseline TR maximal velocity (Vmax), longer baseline QRS duration, and a higher frequency of LVSP. On multivariable analysis, AF (odds ratio [OR], 12.55; 95% confidence interval [CI], 3.18-49.55), LVSP (OR, 9.08; 95% CI, 2.35-35.12), baseline TR Vmax of ≥2.8 m/second (OR, 4.19; 95% CI, 1.20-14.60), and baseline QRS duration of ≥120 ms (OR, 3.80; 95% CI, 1.01-14.32) were independently associated with incident TR.

Incident TR occurred in 6.7% of patients following successful LBBAP. LVSP, prevalent AF, elevated TR Vmax, and prolonged QRS duration were independent predictors of incident TR.