Conduction system pacing in prosthetic heart valves

Background There has been increasing interest in physiologic pacing techniques that directly activate the specialized conduction system. We aimed to assess outcomes of conduction system pacing (CSP) in patients with prosthetic heart valves. Methods This systematic review was performed according to PRISMA guidelines. Freeman-Tukey double arcsine transformation with the random-effect model was used to summarize the data. Outcomes studied were 1) implant success (defined as ability to recruit the His-Purkinje system or the distal Purkinje system); (2) lead parameters at implant and follow-up; and (3) procedure-related complications. Results This systematic review of 7 studies included 267 unique patients in whom CSP was attempted with either HBP or LBBAP for pacing indications after a prosthetic valve. HBP was attempted in 38% (n = 108), while LBBAP in 62% (n = 175) patients. The overall success rate of CSP was 87%, while in patients post-TAVR, the overall success rate was 83.2%. In the subgroup analysis, LBBAP had a significant higher overall success rate compared to HBP (94.3% vs. 76.5%, p (interaction) = 0.02) and post-TAVR patients (94.3 vs. 66.9%, p (interaction) < 0.01), respectively. The LBBAP thresholds were significantly lower compared to HBP both at implant (0.67 +/- 0.4 @ 0.44 ms vs. 1.35 +/- 1 @ 0.85 ms, p (interaction) < 0.01) and at a mean follow-up of 12.4 +/- 8 months (0.73 +/- 0.1 @ 0.44 ms vs. 1.39 +/- 1 @ 0.85 ms, p (interaction) < 0.01), respectively. Conclusion CSP is safe and feasible in patients with a prosthetic valve, with a significantly higher success rate and superior lead parameters with LBBAP than HBP, especially in patients post-TAVR.