Left Bundle Branch Versus Apical Pacing in Atrioventricular Block and Normal Cardiac Function Post-transcatheter Aortic Valve Implantation: PhysTAVI Trial

Background: There is currently no evidence of the best pacing mode for high-degree atrioventricular (AV) block occurring after transcatheter aortic valve implantation (TAVI). The objective of this pilot study was to compare a clinical combined endpoint achieved by left bundle branch pacing (LBBP) vs right ventricular (RV) pacing in patients with preserved left ventricular ejection fraction (LVEF) post-TAVI at 12-month follow-up. Methods: Consecutive patients post-TAVI with high-degree AV block and LVEF ≥ 50% were randomized to LBBP or RV pacing. The primary endpoint was survival with an improvement of ≥ 1 point in New York Heart Association functional class or a ≥ 25% increase in distance covered on the 6-minute walking test. Secondary endpoints were change in LVEF, septal flash, mitral regurgitation, N-terminal pro-brain natriuretic peptide, heart failure hospitalization, score on symptoms, and QRS duration. Results: = 0.03). There was no difference between groups on any other endpoint. Conclusions: Similar midterm outcomes were obtained with LBBP and RV pacing in an elderly population with high-degree AV block and preserved LVEF after TAVI. The pilot Phys-TAVI trial showed the feasibility of LBBP in this population. Larger randomized clinical trials with longer follow-up are needed to test for differential clinical outcomes between pacing modalities. Clinical Trial Registration: NCT04482816.