Single center experience with conduction system pacing in patients after transcatheter aortic valve implantation and atrioventricular conduction disturbances

Background

Conduction system pacing (CSP), including left bundle branch area pacing (LBBAP) provides physiological left ventricular electrical activation pattern, with the possibility to prevent conventional right ventricular pacing induced cardiomyopathy and heart failure. Atrioventricular block (AVB) frequently occurs after transcatheter aortic valve implantation (TAVI) requiring permanent pacemaker (pPM) implantation, with a higher risk of heart failure and mortality among these patients during follow-up.

Purpose

Our aim was to evaluate the feasibility, periprocedural data and short term follow up of CSP implantation in patients after TAVI in comparison with all other CSP patients without TAVI performed in our tertiary referral center.

Methods

In our retrospective study we included 184 consecutive patients implanted with CSP pPM system between november 2023 and november 2025. The primary pacing strategy was LBBAP in the majority of the cases. Thirty patients (21 male, age: 79,7±6,2 yrs) underwent the CSP implantation after TAVI due to AVB (TAVI-group). We created the control group from the remaining 154 patients (102 male, age: 66,7±18 yrs) (non-TAVI group).

Results

The two groups did not differ in terms of gender ratio (21/30 vs. 102/154, p=0.69), but patients in the TAVI group were older (p<0.05). Patients with reduced ejection fraction were present in equal proportions across the goups (55.3% vs. 54.0%, p=0.69). The acute success rate of the procedures was similar (94.8% vs. 93.3%, p=0.74), although the procedure time was shorter in the TAVI group. (41.8±13 vs. 55.05±28 min, p=0.02). There was no difference in post-procedural ECG parameters in tems of QRS width (102.2±9.5 vs. 103.6±11.4 msec, p=0.46), V6 RWPT representing left ventricular activation time (85.2±10.8 vs. 80.6±13.5 msec, p=0.16), and the V6-V1 interpeak interval characterizing selective left Tawara branch stimulation (36.9±11.4 vs. 39.5±8.5 msec p=0.19). No periprocedural complications developed in the TAVI group. During follow-up, CSP lead repositioning was performed in one patient due to macrodislocation. QRS width, electrical lead parameters and left ventricular ejection fraction did not change significantly in either group during the mean follow-up of 7,2±5,4 months.

Concludion: Conduction system pacing is safe and feasible pacing approach in patients after TAVI, promoting the preservation of physiological left ventricular activation and preventing the adverse effects of right ventricular pacing.