Conduction system pacing after TAVR linked to improved outcomes in new meta-analysis
Choosing conduction system pacing (CSP) after transcatheter aortic valve replacement (TAVR) instead of right ventricular pacing (RVP) may be associated with certain benefits, according to a new meta-analysis published in Heart Rhythm O2.[1]
“CSP, achieved by his bundle pacing (HBP) or left bundle branch pacing (LBBP), preserves physiological ventricular activation and may overcome the limitations of RVP,” wrote first author Alexandru Deaconu, MD, a researcher with the Carol Davila University of Medicine and Pharmacy in Romania, and colleagues
Deaconu et al. explored data from nearly 800 patients who originally participated in one of eight clinical studies. All patients required a permanent pacemaker after undergoing TAVR. While 400 patients were treated with CSP—either LBBP or HBP—the other patients were all treated with RVP. The median follow-up period was 15 month. More than 90% of participating patients received a self-expanding TAVR valve.
Baseline characteristics between the CSP and RVP groups were comparable. For example, the mean ages were 77.1 years old for the CSP group and 76.9 years old for the RVP group.
All-cause mortality and cardiovascular mortality were similar for the two treatment groups. Likewise, no significant differences were identified in terms of ventricular lead impedance, sensing or lead dislodgement.
However, CSP was linked to a significantly shorter paced QRS duration after implant and a higher left ventricular ejection fraction after 15 months. Also, CSP was linked to a reduced risk of heart failure rehospitalization.
“These findings suggest that CSP is a safe and physiological alternative to RVP for post-TAVR conduction disturbances, although large-scale randomized controlled trials are needed to confirm the long-term clinical benefit,” the authors wrote.
Click here to read the full study in Heart Rhythm O2, a Heart Rhythm Society publication.
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