Impact of stylet-driven lead for left bundle branch area pacing on tricuspid valve function: A comparative analysis with conventional CRT

BACKGROUND: Cardiac implantable electronic devices (CIED) have been associated with an increased incidence of tricuspid regurgitation (TR) due to several factors. METHODS: We examined the outcomes of patients who underwent left bundle brunch area pacing (LBBAP) with stylet-driven leads and compared them with a 1:1 matched historical cohort of patients treated with conventional cardiac resynchronization therapy (CRT). RESULTS: This retrospective analysis included a total of 396 patients, of whom 132 underwent LBBAP and 264 underwent CRT. After propensity score matching, 95 patients were included in each group. Baseline tricuspid regurgitation severity and left ventricular ejection fraction were also similar. However, diabetes mellitus was more prevalent in the CRT group (47.4% vs. 30.5%, p = 0.02). At follow-up, rates of TR improvement and worsening were low and comparable between LBBAP and CRT. Left ventricular ejection fraction (LVEF) at follow-up was numerically higher in the LBBAP group, while the proportion of patients achieving ≥ 5% LVEF improvement was identical in both groups (41%). Within the LBBAP cohort, TR worsening occurred predominantly in patients with two trans-tricuspid leads and was numerically more frequent in ICD recipients. A shorter annulus-to-lead distance was associated with a trend toward greater TR progression. CONCLUSION: No significant differences in TR severity were observed between the LBBAP and conventional CRT groups. In the LBBAP cohort, TR progression was more common in patients with multiple leads traversing the tricuspid valve and a shorter tricuspid annulus-LBBAP lead distance. Due to the limited statistical power of the study, these observations should be considered hypothesis-generating.