Left bundle branch pacing after transcatheter aortic valve implantation. Initial experience of a center

Introduction

Permanent pacing is often needed in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) due to new onset conduction disorders. Nevertheless, continuous right ventricular pacing may deteriorate left ventricular ejection fraction (LVEF) and lead to poor outcomes. Thus, in last years, more physiological forms of pacing, such as left bundle branch pacing (LBBP) have been developed to prevent pacing induced cardiomyopathy.

Purpose

The aim of our study is to describe the initial experience in our center, evaluate the safety and feasibility of LBBP after TAVI and describe electrophysiological outcomes in the first months of follow-up.

Methods

We designed a prospective registry that collected all patients from the TAVI program of our center who developed conduction abnormalities in the immediate postoperative and received LBBP. We analyzed baseline characteristics, complications and procedure time, electrophysiological parameters after the procedure and final QRS interval. During follow-up LVEF, electrophysiological parameters and adverse clinical events (readmissions for heart failure, cardiovascular mortality and all-cause of mortality) were also evaluated at 3rd, 6th and 12th month.

Results

Between January 2020 and January 2022, twenty patients who developed conduction abnormalities after TAVI underwent LBBP. Seven patients (35%) had a complete atrioventricular block, two patients (10%) alternating bundle branch block and 11 (55%) had a new left bundle branch block. HV electrophysiology study was performed in 8 patients, with a median value of 68ms (66–72).

Of the 20 patients, 3 out of 4 patients were male and had history of hypertension. 40% had previous ischemic heart disease and one patient had transthyretin cardiac amyloidosis. Median age was 79 years-old (76–83.5). Balloon-expandable prosthesis was implanted in 11 patients while 9 received a self-expandable prosthesis. Median basal LVEF was 59% (41.5–60) and median NTproBNP was 1722pg/ml (535–5848).

LBBP was successful in all of the 20 patients. The median time of the procedure was 60 minutes (45–80) without suffering any complications. The median QRS interval before the procedure was 155ms (140–158) and 116ms (105–125) post-implant.

To date, two patients have died of non-cardiac cause 3 and 8 months after LBBP. There have been no readmissions for heart failure. LVEF (pre and post-LBBP) and electrophysiological parameters post-implant and three-month follow-up are shown in Table 1.

Conclusions

In our experience, LBBP after TAVI is a safe and feasible procedure. Despite the small sample size and short follow-up period, our first results indicate stability of LVEF and pacemaker parameters.

Funding Acknowledgement

Type of funding sources: None.

Are there gender differences in the non-prescription of Implantable Cardioverter-Defibrillators (ICDs) in primary prevention? A single-center series

Funding Acknowledgements

Type of funding sources: None.

Introduction

Primary prevention of sudden cardiac death is the main indication for ICD implantation, mainly based on left ventricular ejection fraction (LVEF). Gender differences in the diagnosis and treatment of some cardiology conditions such as myocardial infarction have been previously established.

Purpose

We aim to analyze differences in prognostic variables that could justify gender differences in the non-prescription of an ICD for primary prevention.  

Methods

A retrospective selection of patients from our center during 2019 with ventricular systolic dysfunction (LVED ≤35% in an echocardiogram) was made. We included patients at least one month after an acute myocardial infarction and with optimal medical treatment without an ICD. Death was considered during the year 2019.

Results

 We initially selected 325 patients with ventricular dysfunction, of wich 175 fulfilled the inclusion criteria (67.4% men and 32.6% women). ICD indication was considered in 47 patients out of the 175 selected (29.7% among men and 21.1% among women, p = 0.7; 70.3% among men and 78.9% among women, p= 0.30 for non-prescription). The index left ventricle end-diastolic volume (iLVEDV) was significantly worse in males. Females were older and had lower LVEF.

Conclusion

Although it is a unicenter study and we have only performed univariate comparisons, without considering confounding factors, we found no significant gender differences in prognostic variables that could justify differences in the non-prescription of an ICD for primary prevention. Results Variable Men Women p-value Age (years) 74.53 ± 0.11 79.52 ± 0.15 <0.01 Previous cancer disease 11 (13.25%) 4 (8.89%) 0.77 Cognitive impairment 12 (14.46%) 11 (24.44%) 0.08 NYHA class Mean NYHA class value I (12.05%)II (69.88%)III (18.07%)2.06 ± 0.11 I (6.67%)II (66.67%)III (26.67%)2.20 ± 0.15 0.23 Ischemic etiology 39 (46.99%) 17 (37.78) 0.84 Renal insufficiency 31 (37.35%) 21 (46.67%) 0.15 Syncope or palpitations 16 (19.28%) 8 (17.78%) 0.58 LVEDD index (cm/m2) 2.57 ± 0.11 2.71 ± 0.15 0.23 LVEDV index (ml/m2) 73.18 ± 0.11 66.84 ± 0.15 1 LVEF (%) 28.89 ± 0.11 27.17 ± 0.15 1 Death 17 (20.48%) 8 (17.78%) 0.64 Renal insufficiency: estimated glomerular filtration rate less than 30 ml/min/1,73m2 or dialysis. LVEDD: left ventricle end-diastolic diameter. NYHA: New York Heart Association.