Abstract
BACKGROUND: The impact of left bundle branch area pacing (LBBAP) on the tricuspid valve apparatus (TVA) have not yet been entirely investigated. OBJECTIVE: This prospective study aimed to: (1) compare the impact of LBBAP and right ventricular apical pacing (RVAP) leads on TVA; (2) evaluate the incidence of new-onset lead-induced tricuspid regurgitation (LITR) or worsening of preexisting TR (WTR); and (3) assess the early impact of pacing type on left ventricular (LV) function (4) detect early complications. METHODS: This observational study included consecutive patients undergoing either RVAP or LBBAP lead implantation. 3-dimensional transthoracic echocardiography (3D-TTE) was performed before and the day after cardiac implantable electronic devices (CIED) implantation. RESULTS: A total of 115 patients were enrolled: 45 received LBBAP and 70 patients received an RVAP lead. Lead-leaflet impingement was observed in 49 of 115 patients (42.6%): 28 of 70 (40%) in the RVAP group and 21 of 45 (46.7%) in the LBBAP group (ns). In the LBBAP group, leads crossed the TV more frequently in the anterior area (19/45; 42%), whereas RVAP leads crossed more often in the posteroseptal area (50/70; 71.5%), (P = .025). The incidence of new-onset LITR or WTR was low (8%, 5/66) but represented 19% (5/26) of patients with leaflet impingement (P = .016). LBBAP was associated with an immediate LV function beneficial effect. Post-implantation TTE revealed complications including 3 CIED-related Takotsubo syndrome. CONCLUSION: This study found that LBBAP leads cross the tricuspid valve more frequently in the anterior area, whereas RVAP leads tend to cross in a posteroseptal position. Early worsening of TR after CIED implantation was uncommon.