Author + information
- Received December 3, 2019
- Revision received February 18, 2020
- Accepted February 21, 2020
- Published online May 5, 2020.
- Pugazhendhi Vijayaraman, MDa,∗ ( )(, )
- Óscar Cano, MD, PhDb,
- Jacob S. Koruth, MDc,
- Faiz A. Subzposh, MDa,
- Sudip Nanda, MDd,
- Jessica Pugliese, B.S,RT(R), RCESa,
- Venkatesh Ravi, MDe,
- Angela Naperkowski, RN, CEPS, CCDSa and
- Parikshit S. Sharma, MD, MPHe
- aGeisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes Barre, Pennsylvania
- bHospital Universitari i Politècnic La Fe, Valencia, Spain
- cMount Sinai Medical Center, New York, New York
- dSt. Luke’s University Hospital, Bethlehem, Pennsylvania
- eRush University Medical Center, Chicago, Illinois
- ↵∗Address for correspondence:
Dr. Pugazhendhi Vijayaraman, Geisinger Commonwealth School of Medicine, Geisinger Heart Institute, MC 36-10; 1000 East Mountain Boulevard, Wilkes-Barre, Pennsylvania 18711.
Objective This study aimed to assess the feasibility and success rates of permanent His-Purkinje conduction system pacing (HPCSP) in patients requiring pacing after transcatheter aortic valve replacement (TAVR).
Background TAVR is associated with increased risk for atrioventricular block. HPCSP has the potential to reduce electromechanical dyssynchrony associated with right ventricular pacing. The feasibility and safety of HPCSP in this population are unknown.
Methods Consecutive patients requiring pacemakers after TAVR in whom His bundle pacing (HBP) and/or left bundle branch area pacing (LBBAP) was attempted at 5 centers were included in the study. Implant success rates, pacing characteristics, QRS duration, and left ventricular ejection fraction were assessed. Any procedure-related complications, lead revisions, heart failure hospitalizations, and deaths were documented.
Results HPCSP was successful in 55 of 65 (85%) patients studied. HBP was successful in 29 of 46 patients (63%), and LBBAP was successful in 26 of 28 (93%) patients in whom it was attempted. HBP was more successful in patients with Sapien valves than in those with CoreValves (69% vs. 44%; p < 0.05). LBBAP was associated with lower pacing thresholds and higher R-wave amplitudes at implantation compared with HBP (0.64 ± 0.3 at 0.5 ms vs. 1.4 ± 0.8 at 1 ms, p < 0.001; 14 ± 8 mV vs. 5.5 ± 5.6 mV, p < 0.001). Pacing thresholds remained stable and left ventricular ejection fraction remained unchanged during a mean follow-up of 12 ± 13.7 months.
Conclusions HPCSP is feasible in the majority of patients requiring pacemakers post-TAVR. Success rates of HBP were lower in patients with CoreValves compared to Sapien valves. LBBAP was associated with higher success rates and lower pacing thresholds compared with HBP.
Dr. Vijayaraman has received honoraria, been a consultant, conducted research, and received fellowship support from Medtronic; has been a consultant for Boston Scientific, Abbott, and Biotronik; and has a patent pending for the His bundle pacing delivery tool. Dr. Cano has been a consultant for Medtronic. Dr. Koruth has been a consultant for Abbott, Farapulse, VytronUS, and CardioFocus; has served on the advisory board for Medtronic and Farapulse; and has received research grants from Farapulse, VytronUS, CardioFocus, Biosense, and Affera, Inc. Dr. Subzposh has received honoraria from Medtronic. Dr. Sharma has received honoraria from Medtronic and has been a consultant for Medtronic, Abbott, Boston Scientific, and Biotronik. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received December 3, 2019.
- Revision received February 18, 2020.
- Accepted February 21, 2020.
- 2020 American College of Cardiology Foundation
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