TRICUSPID regurgitation outcomes were comparable in patients undergoing left bundle branch area pacing (LBBAP) and conventional cardiac resynchronisation therapy (CRT), according to a retrospective analysis of matched patient cohorts.
Cardiac implantable electronic devices have been associated with tricuspid regurgitation, raising concerns about potential valve dysfunction following device implantation.
To assess the impact of stylet driven leads used for LBBAP, researchers compared outcomes in patients receiving this pacing approach with those treated using conventional CRT.
The study included 396 patients overall, comprising 132 who underwent LBBAP and 264 who received conventional CRT.
Following propensity score matching based on left ventricular ejection fraction (LVEF) and tricuspid regurgitation severity, 95 patients were retained in each group.
Baseline tricuspid regurgitation severity and LVEF were similar between cohorts, although diabetes mellitus was more common in the CRT group.
During follow-up, researchers found no statistically significant difference in tricuspid regurgitation progression between the two pacing strategies.
Improvement in tricuspid regurgitation severity occurred in 5.3% of patients who underwent LBBAP and 6.3% of those receiving conventional CRT. Worsening was observed in 8.4% and 5.3% of patients, respectively.
Mean follow up duration was 227±290 days, with a median of 145 days. LVEF at follow-up was numerically higher in the LBBAP group compared to the CRT group.
However, the proportion of patients achieving an absolute improvement in LVEF of at least 5% was identical in both groups at 41.1%.
These findings suggest that stylet-driven LBBAP did not result in greater tricuspid valve dysfunction than conventional CRT within the study period.
Within the LBBAP cohort, investigators explored factors associated with tricuspid regurgitation progression.
Among patients with two leads crossing the tricuspid valve, tricuspid regurgitation worsening occurred in 11.9%, whereas no worsening events were observed among those with a single trans-tricuspid lead.
The researchers also identified a potential relationship between lead position and valve function.
Patients with a shorter distance between the tricuspid annulus and pacing lead showed a numerically higher rate of tricuspid regurgitation worsening compared with those with a greater distance, although this association did not reach statistical significance.
The researchers concluded that stylet-driven LBBAP demonstrated a similar effect on tricuspid valve function to conventional CRT.
However, they noted that the findings should be considered hypothesis generating because of limited statistical power and called for larger prospective studies to confirm these observations.
Reference
Bocchini Y et al. Impact of stylet-driven lead for left bundle branch area pacing on tricuspid valve function: A comparative analysis with conventional CRT. J Interv Card Electrophysiol. 2026;DOI:10.1007/s10840-026-02399-3
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