Non-conventional pacing (CRT and LBBAP) in cardiac amyloidosis improved NYHA class (P=0.005) and CRT reduced QRS duration (-8ms vs +27ms; P=0.002) compared to conventional pacing.
Observational (n=312)
No
Does non-conventional pacing (CRT or LBBAP) improve clinical, electrical, and functional outcomes compared to conventional pacing in patients with cardiac amyloidosis?
In patients with cardiac amyloidosis, non-conventional pacing (CRT or LBBAP) is associated with improved heart failure symptoms and echocardiographic parameters compared to conventional pacing.
Absolute Event Rate: -8% vs 27%
p-value: p=0.002
Abstract Introduction Cardiac amyloidosis (CA) is linked to conduction disturbances requiring pacing therapy, which may include conventional pacemaker (PPM) implantation or cardiac resynchronization therapy (CRT). Left bundle branch area pacing (LBBAP) has emerged as an alternative, offering physiological pacing. Limited evidence compares the outcomes of conventional (PPM) vs. non-conventional pacing (CRT or LBBAP) in CA. Thus, we aimed to evaluate these modalities of pacing in patients with CA. Methods Single-centre study of consecutive CA patients who had a pacemaker implantation and classified as conventional (PPM group) and non-conventional pacing (CRT and LBBAP groups). Baseline clinical, laboratory, and echocardiographic data were collected pre- and post-implantation and differences were evaluated between groups. Results Among 312 CA patients, 50 (16%) received a device implantation: 32 (64%) underwent PPM, 12 (24%) CRT and 6 (12%) LBBAP. The primary indication for PPM was complete heart block (22, 69%), while CRT and LBBAP were primarily indicated for complete heart block (5, 28%) and high-degree AV block with reduced left ventricle ejection fraction (LVEF) (7, 39%). At baseline, CRT and LBBAP patients were more likely to have more symptoms of heart failure (p=0.049), complete LBB block (LBBB) (p=0.028), wider QRS (p=0.003) and more intraventricular desynchrony (p=0.001). CRT patients also had lower LVEF (p0.001). Following implantation, pacing dependency was similar across all three groups during the follow-up. At a mean follow-up of 24 months, CRT and LBBP patients had more pronounced improvement in NYHA class (p=0.005) and less intraventricular desynchrony (p=0.004). CRT patients showed a greater reduction in QRS (+27ms vs. -8ms vs. +24ms for PPM, CRT and LBBAP, respectively; p=0.002). No significant differences were noted in NT-proBNP, LVEF or global longitudinal strain (GLS) (Figure 1). Nonetheless, LBBAP patients showed a modest yet significant improvement in GLS values (+1.9±2.9% for LBBAP, –0.3±0.8% for PPM, and –0.3±4.5% for CRT, p=0.260). At follow-up, 17 (34%) patients died (13 PPM and 4 CRT). Conclusions In patients with CA, CRT and LBBP pacing were more often associated with improved cardiac symptoms and imaging endpoints compared to conventional pacing, despite more severe disease at baseline. However, LBBAP patients experienced a similar increase in QRS duration compared to PPM, likely due to the infiltrative nature of CA and the septal thickening, which may compromise the LBBAP results.
Lima et al. (Sat,) conducted a observational in Cardiac amyloidosis (n=312). Non-conventional pacing (CRT or LBBAP) vs. Conventional pacing (PPM) was evaluated on Change in QRS duration (CRT vs PPM) (p=0.002). Non-conventional pacing (CRT and LBBAP) in cardiac amyloidosis improved NYHA class (P=0.005) and CRT reduced QRS duration (-8ms vs +27ms; P=0.002) compared to conventional pacing.