LBBAP limits hospital readmissions after TAVR
Left bundle branch area pacing (LBBAP) is associated with better long-term outcomes than traditional right ventricular pacing (RVP) when patients require a permanent pacemaker after transcatheter aortic valve replacement (TAVR), according to new findings published in Heart Rhythm.[1]
Permanent pacemaker implantation (PPMI) is a significant complication after TAVR that can have a negative impact on patient care. The study’s authors hoped to see if LBBAP, already shown to benefit patients with bradycardia pacing indications, prove to be valuable when post-TAVR PPMI is necessary.
The group tracked data from 237 TAVR patients treated in China from April 2014 to May 2021. All TAVR procedures were performed using transfemoral access. Patients were not included in this study if they had a permanent pacemaker prior to treatment, experienced a procedural failure or underwent biventricular pacing. The mean age was 74 years old, 63.7% were men and the mean Society of Thoracic Surgeons risk score was 4.4%. The mean QRS duration prior to TAVR was 111 milliseconds for the LBBAP group and 114 milliseconds for the RVP group.
While 120 patients underwent LBBAP, the remaining 117 patients underwent RVP. Due to the “wide adoption” of LBBAP in China by April 2018, a majority of RVP patients were treated from 2014 to 2018.
The TAVR procedures were all successful, major procedure-related complications were rare and just two patients presented with significant aortic regurgitation at discharge. The most common reason care teams chose to perform PPMI were high-degree or complete atrioventricular block (67%), and nearly all (86%) of the implanted devices were dual-chamber pacemakers.
During the final follow-up following treatment, the LBBAP group was linked to a “significantly longer” QRS duration (151 milliseconds) than the RVP group (122 milliseconds). While the ventricular pacing threshold was “slightly smaller” in the RVP group, there were no considerable differences in sensing threshold or impedance.
The study’s primary endpoint, all-cause mortality and heart failure hospitalizations, was not significantly different after making certain adjustments. However, looking just at heart failure hospitalizations after five years did reveal a significant difference: they were seen in 21.4% of patients from the RVP group and just 7.5% from the LBBAP group. In addition, the left ventricular ejection fraction (LVEF) improvement over time was more significant for patients in the LBBAP group.
“LBBAP is a feasible and effective physiologic pacing modality for TAVR patients in need of permanent pacemaker,” wrote corresponding author Mao Chen, MD, PhD, a cardiologist with West China Hospital, and colleagues. “LBBAP was associated with significant reduction in heart failure hospitalizations and more LVEF improvement compared to traditional RVP in TAVI patients at long-term follow-up.
Chen et al. did call for more research on this topic, especially in patients with a reduced baseline LVEF. The group also noted that future studies should explore the impact of different valve types. A majority of the TAVR devices patients received in this analysis were self-expanding valves.
Click here to read the full study in Heart Rhythm, a Heart Rhythm Society journal.
Recent FDA approvals for left bundle branch area pacing
The use of LBBAP is gaining significant momentum in the United States. In the last month, for example, Biotronik’s Solia S leads and Boston Scientific’s Ingevity+ pacing leads gained U.S. Food and Drug Administration approval for LBBAP.
Watch an exclusive video interview exploring the potential of LBBAP here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.