ObjectiveTo compare the clinical efficacy of left ventricular wire pacing with traditional right ventricular lead pacing in transcatheter aortic valve replacement. MethodsPerioperative data of patients undergoing transcatheter aortic valve replacement at the Second Hospital of Hebei Medical University from January 2022 to June 2023 were collected. Patients were divided into a left ventricular wire pacing group and a right ventricular lead pacing group based on the pacing method during the procedure, and the clinical data of the two groups were compared and analyzed. ResultsA total of 102 patients were included, with 35 patients in the left ventricular wire pacing group [20 males and 15 females, age (69.2±3.1) years] and 67 patients in the right ventricular lead pacing group [37 males and 30 females, age (70.2±3.7) years]. The hemodynamic characteristics of both groups (peak flow velocity, peak transvalve pressure difference, left ventricular ejection fraction) showed significant improvement post-operation compared to pre-operation (P<0.05). There was no statistically significant difference between the two groups in terms of pacing success rate and surgical complications (P>0.05). Compared to the right ventricular lead pacing group, the left ventricular wire pacing group had shorter operation time [(76.3±17.2) min vs. (86.1±15.3) min, P=0.004] and X-ray exposure time [(18.2±6.1) min vs. (26.2±4.3) min, P<0.001], and lower total hospitalization cost [(213±28) thousand yuan vs. (262±25) thousand yuan, P<0.001]. ConclusionThe safety and reliability of left ventricular wire pacing in transcatheter aortic valve replacement are similar to those of traditional right ventricular lead pacing. Moreover, it can significantly reduce the operation and X-ray exposure time and decrease the total clinical hospitalization cost, making it a viable alternative to traditional right ventricular lead pacing.