Left bundle branch area pacing was associated with markedly fewer heart failure worsening events compared to right ventricular pacing (9.1% vs 69.2%, p=0.0012) in cardiac amyloidosis.
Observational (n=35)
No
Does left bundle branch area pacing prevent heart failure progression compared to right ventricular pacing in patients with cardiac amyloidosis?
In patients with cardiac amyloidosis, left bundle branch area pacing is safe and significantly reduces heart failure worsening and hospitalizations compared to conventional right ventricular pacing.
Absolute Event Rate: 9.1% vs 69.2%
p-value: p=0.0012
Abstract 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 safe in cardiac amyloidosis and may prevent HF progression compared with RVP, even in advanced disease. These findings support LBBAP as a preferred pacing strategy in CA, warranting validation in larger prospective studies
Mussigbrodt et al. (Mon,) conducted a observational in Cardiac amyloidosis (n=35). Left bundle branch area pacing (LBBAP) vs. Right ventricular pacing (RVP) was evaluated on Heart failure worsening (p=0.0012). Left bundle branch area pacing was associated with markedly fewer heart failure worsening events compared to right ventricular pacing (9.1% vs 69.2%, p=0.0012) in cardiac amyloidosis.