Abstract 4144674: Left Versus Right Ventricular Pacing during TAVR and Balloon Aortic Valvuloplasty: A Systematic Review and Meta-Analysis

Introduction: While right ventricular pacing (RVP) is the conventional temporary pacing modality used for transcatheter aortic valve replacement (TAVR), this approach possesses inherent risks and procedural challenges. We aim to assess and compare safety and efficacy of left ventricular pacing (LVP) and RVP during TAVR and balloon aortic valvuloplasty (BAV). Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive literature search was conducted in four databases from inception to December 15 th , 2023. We included observational studies and clinical trials comparing LVP with RVP during TAVR and BAV procedures. The risk ratio (RR) with a 95% confidence interval (CI) was used to compare dichotomous outcomes, while continuous outcomes were reported in form of mean difference (MD). Results: Five studies involving 830 patients with RVP and 1577 with LVP were included. Short-term mortality was significantly higher in the RVP group (RR 2.32, 95% CI: [1.37-3.93], P = 0.002), as was the incidence of cardiac tamponade (RR 2.19, 95% CI: [1.11-4.32], P = 0.02). Subgroup analysis of the TAVR studies only revealed similar trends with higher short-term mortality in the RVP group (RR 1.99, 95% CI: [1.13-3.51], P-value = 0.02). LVP demonstrated shorter hospital stays (MD = 1.34 d, 95% CI: [0.90, 1.78], P<0.001) and reduced procedure duration (MD = 7.75 min, 95% CI: [5.08, 10.41], P<0.00001) compared to RVP. New pacemaker implantation was higher in the RVP group (RR 2.23, 95% CI: [1.14, 4.39], P = 0.02). Major vascular complications (RR 1.78, 95% CI: [0.86-3.70], P-value = 0.12), Cerebrovascular accidents (RR 1.67, 95% CI: [0.78-3.57], p-value = 0.18) and all bleeding (RR 0.95, 95% CI: [0.51-1.76], p-value = 0.86) were all comparable between both groups. Conclusion: Left ventricular pacing is a plausible alternative to RV pacing in patients undergoing TAVR or valvuloplasty, particularly in the absence of high-grade conduction disturbances. LV pacing has demonstrated superior outcomes with lower short-term mortality rates, lower incidence of cardiac tamponade, and pacemaker implantation. On the other hand, RV pacing could be the preferred modality of treatment if baseline conduction abnormalities are present.