Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026
Left Bundle Branch Area Pacing versus Right Ventricular Pacing in Cardiac Amyloidosis: the Left-Right CA study, a single center, retrospective comparative non-randomized analysis.
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Müssigbrodt Andreas, Bethencourt Maria Herrera, Lounaci Karima, Montereggi Francesco, Vergier Romain, Cohen Mickael, Bouvagnet Patrice, Kristen Arnt, Imnadze Guram
Аннотация
BACKGROUND: Cardiac amyloidosis (CA), particularly transthyretin-related (ATTR-CA), frequently causes conduction disease requiring pacing. Conventional right ventricular pacing (RVP) may worsen heart failure (HF) through dyssynchronous activation, while left bundle branch area pacing (LBBAP) provides a more physiological alternative. Comparative data in CA are lacking.
METHODS: This single-center, retrospective study included CA patients with CIED (cardiac implantable electronic devices) with LBBAP and RVP. It aimed to compare feasibility, procedural characteristics, and outcomes between both approaches. Diagnosis of CA followed current guideline criteria. HF worsening was defined as clinical deterioration requiring escalation of diuretics or outpatient reassessment; acute HF events as hospitalizations for decompensated HF.
RESULTS: 35 CA patients (22 LBBAP, 13 RVP) were included. Overall, 32 (91%) had transthyretin cardiac amyloidosis (ATTR-CA) and 3 (9%) light-chain amyloidosis (AL-CA). Baseline HF was more advanced in the LBBAP group (NYHA 2.6 ± 0.7 vs. 2.0 ± 0.6, p = 0.007; BNP 594 ± 617 vs. 121 ± 71 pg/mL, p = 0.006). Procedural and fluoroscopy times were longer with LBBAP, but paced QRS duration was significantly shorter (116 ± 17 vs. 159 ± 12 ms, p < 0.001). During follow-up (16 ± 10 vs. 32 ± 24 months), LBBAP was associated with markedly fewer HF worsening (9.1% vs. 69.2%, p = 0.0012) and acute HF events (4.5% vs. 69.2%, p < 0.001), despite higher ventricular pacing burden (> 40% in 90.9% vs. 53.8%, p = 0.032). Mortality (22.7% vs. 15.4%, p = 0.689) and complication rates (9.1% vs. 15.4%, p = 0.618) were comparable.
CONCLUSIONS: LBBAP is feasible and appears safe in patients with cardiac amyloidosis and was associated with fewer heart-failure-related events compared with RVP, even in advanced disease. These findings are hypothesis-generating and warrant validation in larger prospective studies.
METHODS: This single-center, retrospective study included CA patients with CIED (cardiac implantable electronic devices) with LBBAP and RVP. It aimed to compare feasibility, procedural characteristics, and outcomes between both approaches. Diagnosis of CA followed current guideline criteria. HF worsening was defined as clinical deterioration requiring escalation of diuretics or outpatient reassessment; acute HF events as hospitalizations for decompensated HF.
RESULTS: 35 CA patients (22 LBBAP, 13 RVP) were included. Overall, 32 (91%) had transthyretin cardiac amyloidosis (ATTR-CA) and 3 (9%) light-chain amyloidosis (AL-CA). Baseline HF was more advanced in the LBBAP group (NYHA 2.6 ± 0.7 vs. 2.0 ± 0.6, p = 0.007; BNP 594 ± 617 vs. 121 ± 71 pg/mL, p = 0.006). Procedural and fluoroscopy times were longer with LBBAP, but paced QRS duration was significantly shorter (116 ± 17 vs. 159 ± 12 ms, p < 0.001). During follow-up (16 ± 10 vs. 32 ± 24 months), LBBAP was associated with markedly fewer HF worsening (9.1% vs. 69.2%, p = 0.0012) and acute HF events (4.5% vs. 69.2%, p < 0.001), despite higher ventricular pacing burden (> 40% in 90.9% vs. 53.8%, p = 0.032). Mortality (22.7% vs. 15.4%, p = 0.689) and complication rates (9.1% vs. 15.4%, p = 0.618) were comparable.
CONCLUSIONS: LBBAP is feasible and appears safe in patients with cardiac amyloidosis and was associated with fewer heart-failure-related events compared with RVP, even in advanced disease. These findings are hypothesis-generating and warrant validation in larger prospective studies.