# Echocardiographic assessment after left bundle branch area pacing: Impact on the tricuspid valve apparatus, clinical value, and perspectives

## TL;DR

This study compares how two types of heart pacing affect the tricuspid valve and heart function, finding that left bundle branch pacing may be better for preserving valve function.

## Contribution

The study is the first to compare the impact of left bundle branch area pacing and right ventricular apical pacing on the tricuspid valve apparatus using 3D echocardiography.

## Key findings

- LBBAP leads cross the tricuspid valve more frequently in the anterior area compared to RVAP leads.
- New-onset or worsened tricuspid regurgitation was uncommon after pacing lead implantation.
- LBBAP was associated with an immediate beneficial effect on left ventricular function.

## Abstract

The impact of left bundle branch area pacing (LBBAP) on the tricuspid valve apparatus (TVA) have not yet been entirely investigated.

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.

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.

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.

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.