Wang Xi, Xu Yuanning, Zeng Lijun, Tan Kun, Zhang Xueli, Han Xu, Xiong Tianyuan, Zhao Zhengang, Peng Yong, Wei Jiafu, Li Qiao, He Sen, Chen Yong, Zhou Minggang, Li Xi, Wei Xin, Liang Yujia, Zhou Wenxia, Jiang Lingyun, Liu Xingbin, Meng Wei, Zhou Rui, Xiong Guojun, Dai Min, Deng Xiaojian, Feng Yuan, Chen Mao
Department of Cardiology and Laboratory of Cardiac Structure and Function, West China Hospital, Sichuan University, China.
Department of Cardiology, West China Hospital, Sichuan University, China.
Heart Rhythm. 2025 Jul;22(7):1774-1781. doi: 10.1016/j.hrthm.2024.09.021. Epub 2024 Sep 15.
New-onset permanent pacemaker implantation (PPMI) is still a common complication after transcatheter aortic valve implantation (TAVI) with adverse clinical outcomes.
The purpose of this study was to investigate whether left bundle branch area pacing (LBBAP) improves long-term clinical results compared with traditional right ventricular pacing (RVP) in patients requiring PPMI after TAVI.
A total of 237 consecutive patients undergoing RVP (N = 117) or LBBAP (N = 120) after TAVI were retrospectively included. Long-term outcomes, including all-cause death, heart failure rehospitalization (HFH), and left ventricular ejection fraction (LVEF) change compared to baseline, were obtained until 5 years post-TAVI.
The mean age of the overall population was 74 years, with a mean surgical risk score of 4.4%. The paced QRS duration was significantly longer in the RVP group compared with the LBBAP group (151 ± 18 vs 122 ± 12 ms; P < .001). No difference was found between the 2 groups in all-cause death (13.7% vs 13.3%; adjusted hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.37-1.58; P = .466) or the composite endpoint of death and HFH (29.9% vs 19.2%; adjusted HR, 1.22; 95% CI, 0.70-2.13; P = .476); however, the risk of HFH was significantly higher in the RVP group at 5 years after TAVI (21.4% vs 7.5%; adjusted HR, 2.26; 95% CI, 1.01-5.08; P = .048). There was greater improvement of LVEF over time in the LBBAP group (P = .046 for LVEF changes over time between groups).
LBBAP improved long-term clinical outcomes compared with RVP in patients undergoing PPMI after TAVI in terms of less HFH and better LVEF improvement.
新发永久性起搏器植入（PPMI）仍是经导管主动脉瓣植入术（TAVI）后常见的并发症，具有不良临床结局。
本研究旨在探讨在TAVI术后需要PPMI的患者中，与传统右心室起搏（RVP）相比，左束支区域起搏（LBBAP）是否能改善长期临床结果。
回顾性纳入237例TAVI术后接受RVP（n = 117）或LBBAP（n = 120）的连续患者。获取直至TAVI术后5年的长期结局，包括全因死亡、心力衰竭再住院（HFH）以及与基线相比的左心室射血分数（LVEF）变化。
总体人群的平均年龄为74岁，平均手术风险评分为4.4%。RVP组的起搏QRS时限显著长于LBBAP组（151±18 vs 122±12毫秒；P <.001）。两组在全因死亡（13.7% vs 13.3%；调整后风险比[HR]，0.76；95%置信区间[CI]，0.37 - 1.58；P =.466）或死亡和HFH的复合终点方面无差异（29.9% vs 19.2%；调整后HR，1.22；95% CI，0.70 - 2.13；P =.476）；然而，TAVI术后5年时，RVP组的HFH风险显著更高（21.4% vs 7.5%；调整后HR，2.26；95% CI，1.01 - 5.08；P =.048）。LBBAP组随时间推移LVEF改善更大（两组间LVEF随时间变化，P =.046）。
在TAVI术后接受PPMI的患者中，与RVP相比，LBBAP在减少HFH和更好地改善LVEF方面改善了长期临床结局。
