Clinical outcomes of His bundle pacing vs. right ventricular pacing in patients with conduction disturbances following transcatheter aortic valve replacement.

Objective: To assess and compare the clinical outcomes of His bundle pacing (HBP) versus right ventricular pacing (RVP) in patients who develop conduction disturbances following transcatheter aortic valve replacement (TAVR).

Methods: In this retrospective study, 120 patients who developed CD following TAVR were enrolled, and were implanted with HBP or RVP between January 2015 and December 2024. To adjust for variations in initial risk factors and baseline characteristics between patients who underwent HBP or RVP, we employed the propensity score matching. Each patient was matched in a 1:1 ratio with replacement. Patients who either received HBP or RVP, but could not be adequately matched, were excluded from the study population. Procedural and clinical outcomes were compared among different modalities at pacing implantation and12-month follow-up.

Results: Paced QRS duration, R-wave amplitude at implantation and at follow-up, impedance at follow-up were lower in HBP group compared to RVP group. At12-month follow-up, the decrease in pacing burden was significantly greater in the HBP group than in the RVP group. Pacing threshold at implantation and at follow-up and capture threshold at implantation and at follow-up were higher in HBP group compared to RVP group. During follow-up, the left ventricular ejection fraction (LVEF) and tricuspid regurgitation (TR) area in the HBP group showed a significant improvement compared to preoperative values, while no significant increase in LVEF was observed in the RVP group, with a clear statistical difference between the two groups. At 12-month follow-up, NT-proBNP levels in the HBP group were significantly lower than those in the RVP group. The rates of NYHA functional class II were higher, while the rates of NYHA functional class III and MACE were lower in the HBP group compared to the RVP group during follow-up.

Conclusions: HBP was feasible and safe in patients after TAVR, demonstrating a reduction in the composite outcome of MACE and better cardiac function compared to RVP.