Background: Transcatheter aortic valve replacement (TAVR) is associated with increased risk for AV block. His-Purkinje conduction system pacing (HPCSP) has the potential to reduce electromechanical dyssynchrony associated with RV pacing. The feasibility and safety of HPCSP in this population is unknown.
Objective: The aim of our study was to assess the feasibility and success rates of permanent HPCSP in patients requiring pacing following TAVR
Methods: Consecutive patients requiring pacemakers following TAVR in whom His bundle pacing (HBP) and/or left bundle branch area pacing (LBBAP) was attempted at 5 centers were included in the study. Implant success rates, pacing characteristics, QRS duration, and left ventricular ejection fraction (LVEF) were assessed. Any procedure related complications, lead revision, heart failure hospitalization (HFH) and death were documented.
Results: HPCSP was successful in 55 of 65 (85%) patients studied. HBP was successful in 29 of 46 patients (63%) and LBBAP in 26 of 28 (93%) patients in whom it was attempted. HBP was more successful in Sapiens valve compared to CoreValve (69% vs 44%, P<0.05). LBBAP was associated with lower pacing thresholds and higher R-wave amplitudes at implant compared to HBP (0.64±0.3@0.5ms vs 1.4±0.8@1ms, P<0.001; 14±8mV vs 5.5±5.6mV, P<0.001). Pacing thresholds remained stable and LVEF remained unchanged during a mean follow-up of 12±13.7 months.
Conclusion: HPCSP is feasible in the majority of patients requiring pacemaker post-TAVR. Success rates of HBP was lower in patients with CoreValve compared to Sapiens valve. LBBAP was associated with higher success rates and lower pacing thresholds compared to HBP.