His Purkinje conduction system pacing (HPCSP) may be feasible and safe in the majority of patients requiring pacemakers post TAVR, according to research presented May 5 at the 2020 Heart Rhythm Scientific Sessions and simultaneously published in JACC: Clinical Electrophysiology.

Pugazhendhi Vijayaraman, MD, FACC, et al., analyzed patients at five centers who had His bundle pacing (HBP) or left bundle branch area pacing (LBBAP) attempted following TAVR. They assessed implant success rates, pacing characteristics, QRS duration and left ventricular ejection fraction (LVEF).

Results showed that HPCSP was overall successful in 55 of 65 (85%) patients post TAVR patients with a mean age of 79 years. HBP was found to be successful in 29 of 46 patients (63%) while LBBAP was successful in 26 of 28 patients (93%).

Furthermore, the authors found that HBP was more successful in patients with Sapien valves compared with those with CoreValves (69% vs. 44%), and that LBBAP was associated with higher success rates and lower pacing thresholds compared with HBP.

The authors also found pacing thresholds remained stable and LVEF remained unchanged during a mean follow-up of 12 months.

In an accompanying editorial comment, Jordana Kron, MD, FACC, and Santosh K. Padala, MD, FACC, write that "one of the most elegant findings of this work is the validation of the anatomic relationship between the prosthetic aortic valve location and the bundle of His, which can be used to guide physiologic pacing implanters."

They add, "While further studies assessing long-term clinical outcomes with LBBAP are required, this study is a valuable contribution to the literature and provides an impetus for long-term physiologic pacing studies in the post-TAVR population."

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Aortic Surgery, Cardiac Surgery and Arrhythmias

Keywords: Stroke Volume, Ventricular Function, Left, Bundle of His, Transcatheter Aortic Valve Replacement, Aortic Valve, Heart Conduction System, Longitudinal Studies, Ventricular Septum, Pacemaker, Artificial, Electrophysiology

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