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Left Bundle Branch Area Pacing in TAVI patients: a feasible alternative?
Session:
Sessão de Posters 43 - Inovações em Síncope e Pacing Cardíaco
Speaker:
Diogo De Almeida Fernandes
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.6 Device Therapy - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Diogo De Almeida Fernandes; João André Ferreira; Patrícia Alves; Carolina Saleiro; Natália António; Luís Elvas; Lino Gonçalves
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>INTRODUCTION</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conduction system damage with need of pacemaker implantation is one of the most common transcatheter aortic valve implantation (TAVI) complications. Left bundle branch area pacing (LBBAP) has shown promising results in improving cardiovascular outcomes, however, data on LBBAP in TAVI patients is scarce. Our aim was to compare procedural and clinical outcomes of LBBAP and right ventricular pacing (RVp) in TAVI patients.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>METHODS</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Single-center cohort study including consecutive patients who underwent pacemaker implantation (LBBAP or Rvp) following TAVI from Jan to Dec 2023. LBBAP was considered successful with an LV activation time (LVAT) <80ms and/or V6–V1 inter-peak interval >40ms. Primary outcome was defined as a composite of HF emergency department (ER) admission, HF hospitalization and all-cause mortality. </span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>RESULTS</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">19 patients underwent LBBAP and 45 RVp. LBBAP patients were younger [77 interquartile amplitude (AIQ) 11 vs 83 years AIQ 7, p <0.001] and more likely male (84.2% vs 57.8%, p 0.042). There were no further differences on baseline characteristics. Most common indication was complete atrioventricular (AV) block (73.7% LBBAP vs 79.5% RVp). Median left ventricle ejection fraction (LVEF) was lower in LBBAP (55% AIQ 10 vs 57% AIQ 5, p 0.033). Average LVAT was 77±7ms. Paced QRS was significantly shorter in LBBAP (116ms AIQ 10 vs 152ms AIQ 28, p <0.001). Fluoroscopy time was similar (7min AIQ 6vs 8min AIQ11, p 0.223) as well as pacing thresholds (0.6±0.3V vs 0.5±0.3V, p 0.081). Sensing thresholds were higher in LBBAP (15.1mV AIQ 6.8 vs 10.7 AIQ 6.3, p 0.006). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">After a mean follow-up time of 7.9 months, LBBAP patients had a significant increase in LVEF (7% AIQ 13 vs -5% AIQ 7, 0.002). The primary outcome occurred in 15.8% of patients with LBBAP (vs 24.4%, p 0.526). After adjusting for differences at baseline and for patients with pacing percentage greater than 20%, there were no differences between groups. Of note, the hazard curves separate early on, even though no significance was obtained. </span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>CONCLUSION</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">LBBAP led to shorter paced QRS, improved LV function and better acute R-wave amplitudes. Primary endpoint occurred in a similar proportion of the groups, even though the curves separate early on. Early data appears to show LBBAP is a feasible and potentially advantageous technique in TAVI patients.</span></span></p>
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