Temporary Active Fixation Leads in Transcatheter Aortic Valve Replacement Patients With Baseline Right Bundle Branch Block

STRUCTURED ABSTRACT Background Patients with pre-existing right bundle branch block (RBBB) undergoing transcatheter aortic valve replacement (TAVR) are at high risk of complete heart block, often requiring prolonged temporary pacing. Conventional temporary pacing leads are associated with lead dislodgement, immobilization and intensive care unit (ICU) monitoring. The objective of this study was to compare screw-in versus conventional temporary pacing leads after TAVR in patients with pre-existing RBBB. Methods This multicenter observational study included consecutive patients with pre-existing RBBB undergoing TAVR between 2018 and 2024. Patients receiving left ventricular pacing or no postprocedural temporary pacing were excluded. Outcomes included procedural complications, ICU utilization, hospital stay, permanent pacemaker (PPM) implantation and 30-day clinical events. Results Among 544 patients, 124 received a screw-in lead and 420 a conventional lead. Screw-in leads were associated with significantly lower ICU utilization after TAVR (23% vs 99%, p < 0.001). Despite longer temporary pacing duration (2.4 ± 1.4 days vs 1.2 ± 1.6 days, p < 0.001), lead dislodgement was infrequent and numerically lower with screw-in leads (0.8% vs 3.3%). Rates of major vascular complications, bleeding, tamponade, and atrial fibrillation were similar between groups. At 30 days, PPM implantation rates were comparable (50.0% vs 46.2%; p=0.455), whereas hospital stay was shorter with screw-in leads (5.2 ± 4.2 vs 7.4 ± 7.8 days, p < 0.001). Mortality and major adverse events were similar. Conclusions In TAVR recipients with pre-existing RBBB, screw-in temporary pacing leads were associated with reduced ICU utilization and shorter hospitalization without increasing complications or adverse outcomes, supporting their use for prolonged postprocedural monitoring.