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Correction of transcatheter aortic valve replacement induced left bundle branch block by His bundle pacing

Session Managing electrical complications after Transcatheter Aortic Valve Implantation and other percutaneous arrhythmia procedures

Speaker Jan De Pooter

Event : ESC Congress 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Antibradycardia Pacing
  • Session type : Rapid Fire Abstracts

Authors : J De Pooter (Ghent,BE), S Calle (Ghent,BE), M Coeman (Ghent,BE), T Philipsen (Ghent,BE), P Gheeraert (Ghent,BE), L Jordaens (Ghent,BE), P Kayaert (Ghent,BE), F Timmermans (Ghent,BE), F Vanheuverswyn (Ghent,BE)

Authors:
J. De Pooter1 , S. Calle1 , M. Coeman1 , T. Philipsen2 , P. Gheeraert1 , L. Jordaens1 , P. Kayaert1 , F. Timmermans1 , F. Vanheuverswyn1 , 1Ghent University Hospital (UZ), Heart Center - Ghent - Belgium , 2Ghent University Hospital (UZ), Cardiac Surgery - Ghent - Belgium ,

Citation:
European Heart Journal ( 2019 ) 40 ( Supplement ), 3733

Background: Left bundle branch block (LBBB) occurs frequently after transcatheter aortic valve replacement (TAVR) and is associated with increased risk of permanent pacemaker implantation, heart failure hospitalization and sudden cardiac death. This pilot study explored the feasibility of TAVR-induced LBBB correction with His bundle pacing (HBP).

Methods: Patients with TAVR -induced LBBB and postoperative need for permanent pacemaker implant were planned for electrophysiology study and HBP. Patients with persistent high degree AV-block were excluded. HBP was performed using the Select Secure pacing lead, delivered through a fixed curve or a deflectable sheath. Successful HBP was defined as correction of LBBB by selective or non-selective HBP with LBBB correction thresholds less than 3.5V at 1.0ms at implant.

Results: The study enrolled 6 patients (mean age 85±2.5 years, 50% male). Mean QRS duration was 152±10ms, PR-interval 212±12ms AH-interval 166±16ms and HV-interval 62±12ms. Successful HBP was achieved in 5/6 (83%) patients. Mean QRS duration decreased from 153±11ms to 88±14ms (p=0.002). At implantation, mean threshold for LBBB correction was 1.6±1.0V (unipolar) and 2.2±1.3V (bipolar) at 1.0ms. Periprocedural, two complete AV-blocks occurred, both spontaneously resolved by the end of the procedure. Thresholds remained stable at 1 month follow up: 1.8±1.0V (unipolar) and 2.3±1.5V (bipolar) at 1.0ms.

Conclusion: Permanent His bundle pacing can safely correct TAVR-induced LBBB in the majority of patients. Further studies are needed to assess potential benefits of His bundle pacing over conventional right ventricular pacing in this population.

Figure 1

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