Left bundle branch pacing after transcatheter aortic valve implantation: a retrospective study on feasibility, electrical stability, and short-term outcomes
M Nguyen Quang, D Kieu Ngoc, S Nguyen Khac Le, T Nguyen Tri, N Vo Thanh, T Nguyen VanAbstract
Background
Conduction disturbances frequently occur after transcatheter aortic valve implantation (TAVI), often necessitating permanent pacing. Conventional right ventricular pacing may induce ventricular dyssynchrony and aggravate heart failure. Left bundle branch pacing (LBBP) has emerged as a physiological alternative, yet evidence regarding its performance and outcomes after TAVI remains limited.
Purpose
To evaluate the feasibility, procedural characteristics, and short-term outcomes of LBBP in patients requiring permanent pacing after TAVI, using a retrospective single-centre cohort.
Methods
We retrospectively analysed consecutive post-TAVI patients who underwent permanent pacemaker implantation between January 2023 and May 2025 at a tertiary centre. Patients receiving LBBP were identified and evaluated for procedural success, capture thresholds, R-wave amplitude, paced QRS duration, and short-term complications. Follow-up included 6-month device interrogation and echocardiographic assessment. Statistical comparisons used the Mann–Whitney U and chi-square tests, with p < 0.05 considered significant.
Results
Among 27 post-TAVI patients requiring pacing, LBBP was attempted in 21 and successfully achieved in 19 (90 %). Mean capture threshold was 0.7 ± 0.2 V @ 0.5 ms, R-wave amplitude 9.1 ± 3.4 mV, and impedance 612 ± 75 Ω. Paced QRS duration was significantly narrower with LBBP compared to right ventricular pacing (114 ± 12 ms vs 158 ± 20 ms, p < 0.001). No major complications were observed. Over a median 6-month follow-up, pacing parameters remained stable, and no deterioration in left-ventricular ejection fraction or heart failure symptoms was noted.
Conclusions
In this retrospective cohort, LBBP after TAVI demonstrated high procedural success, stable electrical performance, and favourable short-term outcomes. These findings support LBBP as a feasible and physiological pacing modality in post-TAVI patients, warranting larger prospective studies for long-term validation.Baseline and Procedural CharacteristicsComparison of Electrical Parameters