PO-05-026 IMPACT OF LEADLESS PACING ON VENTRICULAR AND VALVULAR FUNCTION

Abstract

Traditional transvenous pacemakers have been associated with worsening tricuspid valve (TV) function due to lead-related leaflet impingement, as well as ventricular dysfunction related to electromechanical dyssynchrony from right ventricular pacing. The effect of leadless pacing on ventricular and valvular function has not been well established. To describe the impact of leadless pacing on ventricular and valvular function In patients who underwent a leadless pacemaker implant at Duke University Hospital between November 11, 2014 and November 18, 2019 and had pre- and post-procedure echocardiographic imaging, echocardiographic features before and after implant were assessed. Valvular regurgitation was graded ordinally from 0 (none) to 3 (severe). Left ventricular function was quantified by left ventricular ejection fraction (LVEF) and right ventricular function by tricuspid annular plane systolic excursion (TAPSE). Among 54 consecutive patients, the mean age was 70.1 ± 14.3 years, 44% were women, and the most frequent pacing indication was complete heart block (44%). The mean right ventricular pacing burden was 48.6 ± 42.6%. Over a mean echocardiographic follow-up time of 28.7 ± 19.8 months, there was no change in regurgitation severity of the mitral valve (mean change -0.17 ± 1.02, p= 0.24), tricuspid valve (mean change 0.07 ± 1.15, p=0.64), or aortic valve (mean change 0.11 ± 0.77, p=0.29) (Figure). There was no significant change in mean bi-atrial or bi-ventricular chamber size. There was a post-implant decrease in mean LVEF (52.3 ± 9.3 to 47.9 ± 12.1, p=0.0019) and TAPSE (1.8 ± 0.6 to 1.6 ± 0.4, p=0.0437) (Table). Neither change in LVEF nor TAPSE correlated with implant location (apical [n=46] vs non-apical septum [n=7]). Overall, 8 patients (15%) were diagnosed with pacing-related cardiomyopathy and 6 (11%) received an upgrade to a transvenous biventricular pacemaker. Patients with leadless pacemakers experienced no significant change in tricuspid regurgitation post-implant. However, right ventricular leadless pacing was associated with reduction in measures of both right and left ventricular function. These findings may impact selection of a leadless versus transvenous pacing system in patients with pre-existing TR or who are vulnerable to decline in ventricular function.