Key result
His bundle pacing linked to ~57% lower MACE risk versus RVP for post-TAVR conduction disturbances.
Why the study?
Clinical outcomes comparing His bundle pacing versus right ventricular pacing in patients developing conduction disturbances following TAVR were not well established.
Does His bundle pacing reduce major adverse cardiovascular events and improve cardiac function compared to right ventricular pacing in patients with conduction disturbances following TAVR?
Cohort (n=120)
Yes
Does His bundle pacing reduce major adverse cardiovascular events and improve cardiac function compared to right ventricular pacing in patients with conduction disturbances following TAVR?
Absolute Event Rate: 33.3% vs 76.7%
p-value: p=< 0.001
His bundle pacing significantly reduces major adverse cardiovascular events and improves left ventricular ejection fraction compared to right ventricular pacing in patients who develop conduction disturbances after TAVR.
Should not yet change post-TAVR pacing practice; hypothesis-generating and leaves open need for randomized confirmation.
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.
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Zhang et al. (2025) conducted a cohort in Conduction disturbances following transcatheter aortic valve replacement (n=120). His bundle pacing (HBP) vs. Right ventricular pacing (RVP) was evaluated on Major adverse cardiovascular events (MACE) (p=< 0.001). His bundle pacing reduced major adverse cardiovascular events to 33.3% compared to 76.7% with right ventricular pacing in patients with conduction disturbances following TAVR.
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