Feasibility and safety of left bundle branch area pacing in cardiac amyloidosis. A single center experience
Chinh Pham‐Trung, Darwin Veloza‐Urrea, Melodie Segura‐Domínguez, Yuleisy De la Rosa Rojas, Cristina Aguilera‐Agudo, Eusebio Alejandro García‐Izquierdo, Daniel García‐Rodríguez, Diego Jiménez‐Sánchez, Alvaro Lorente‐Ros, Susana Mingo‐Santos, Esther Gonzalez‐Lopez, Fernando Domínguez, Pablo Garcia‐Pavia, Jorge Toquero‐Ramos, Ignacio Fernández‐Lozano, Víctor Castro‐Urda- Cardiology and Cardiovascular Medicine
- General Medicine
Abstract
Background
Conventional right ventricle (RV) pacemaker stimulation has been associated with worse clinical outcomes in patients with cardiac amyloidosis (CA). Left bundle branch area pacing (LABPP) has been suggested as a promising alternative. We sought to assess the safety, feasibility, and outcomes of LABPP in patients with CA.
Methods
We retrospectively analyzed echocardiography and pacing parameters and clinical outcomes in 23 consecutive patients with CA and LBBAP implanted from June 2020 to October 2022.
Results
LBBAP was successfully performed in 22 over 23 patients (19 male, 78.6 ± 11.7 years, 20 ATTR, mean LVEF 45.5 ± 16.2%). After the procedure, 9 patients showed Qr pattern and 11 a qR pattern in V1 on ECG. Average procedure time was 67 ± 28 min. After 7.7 ± 5.2 months follow‐up, no procedure‐related complications had occurred. Although, a significant reduction in QRS width (p = .001) was achieved, we did not observe significant changes in LVEF and Nt ProBNP at 6 months of follow‐up. Pacing parameters were stable during follow‐up: LBB capture threshold and R wave amplitude were 1.0 ± 0.5 V and 10.6 ± 6.0 mV versus 0.8 ± 0.1 V, p = .21 and 10.6 ± 5.1 mV (p = .985) at follow up.
Conclusion
LBBAP is safe and feasible pacing technique for patients with CA. LBBAP is associated with significant narrowing of QRSd without worsening in LVEF and Nt‐proBNP.