Left bundle branch area pacing decreased the pressure gradient and severity of tricuspid regurgitation compared with right ventricular pacing

Background: Right ventricular pacing (RVP) is associated with the progression of tricuspid regurgitation (TR). Left bundle branch area pacing (LBBAP) has been considered a more physiological procedure. Hence, we aimed to investigate the TR variation and associated clinical outcomes after LBBAP implantation. Methods: We retrospectively analyzed 492 patients receiving a new pacemaker implantation between 2018 January and 2024 December, consisting of 241 patients with LBBAP and 251 patients with RVP. Primary outcomes were the deterioration or regression of TR grade, and the progression of tricuspid regurgitation pressure gradient (TRPG). Results: During a mean follow-up period of 2.17 ± 0.87 years, the LBBAP group had a lower incidence of TRPG progression (P = 0.010), and a higher incidence of TR regression (P = 0.016) compared with the RVP group. Kaplan–Meier survival curve analysis revealed that the LBBAP group had a lower cumulative incidence of TRPG progression compared with the RVP group (Log-rank test, P = 0.023). Furthermore, the patients with TRPG progression had a higher cumulative incidence of heart failure hospitalization compared with those without TRPG progression (Log-rank test, P < 0.001). Only in patients with heart failure with reduced ejection fraction, the incidence of TR progression was lower in the LBBAP group than the RVP group (P = 0.019). Conclusions: In this study, we found that LBBAP, compared with RVP, may prevent TRPG progression, have the benefit of TR improvement, and decrease TR progression in patients with heart failure with reduced ejection fraction, probably leading to decrease heart failure hospitalization.