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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

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) provide...

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Main Authors: Müssigbrodt, Andreas (Author) , Bethencourt, Maria Herrera (Author) , Lounaci, Karima (Author) , Montereggi, Francesco (Author) , Vergier, Romain (Author) , Cohen, Mickael (Author) , Bouvagnet, Patrice (Author) , Kristen, Arnt (Author) , Imnadze, Guram (Author)
Format: Article (Journal)
Language:English
Published: 24 March 2026
In: Journal of interventional cardiac electrophysiology
Year: 2026, Pages: 1-9
ISSN:1572-8595
DOI:10.1007/s10840-026-02276-z
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1007/s10840-026-02276-z
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Author Notes:Andreas Müssigbrodt, Maria Herrera Bethencourt, Karima Lounaci, Francesco Montereggi, Romain Vergier, Mickael Cohen, Patrice Bouvagnet, Arnt Kristen, Guram Imnadze
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Summary: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.
Item Description:Online veröffentlicht: 24. März 2026
Gesehen am 29.04.2026
Physical Description:Online Resource
ISSN:1572-8595
DOI:10.1007/s10840-026-02276-z

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