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Left bundle branch area pacing in patients with transthyretin cardiac amyloidosis: a case series

Keisuke Miyajima1, Wakaba Kobayashi1, Shogo Hakamata1

  • 1Department of Cardiology, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ward, Hamamatsu, Shizuoka 433-8558, Japan.

European Heart Journal. Case Reports
|January 16, 2025
PubMed

Insights

Left bundle branch area pacing offers a safe and effective solution for atrioventricular block in transthyretin cardiac amyloidosis patients. This physiological pacing method avoids complications seen with traditional right ventricular pacing.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Amyloidosis Research

Background:

  • Transthyretin cardiac amyloidosis frequently causes arrhythmias like atrioventricular block.
  • Effective treatments for these arrhythmias are currently limited.
  • Left bundle branch area pacing (LBBAP) is an emerging physiological pacing technique.

Observation:

  • A case series involving three patients with transthyretin cardiac amyloidosis and atrioventricular block is presented.
  • All patients had significant ventricular septal hypertrophy.
  • LBBAP was successfully performed without complications in all cases.

Findings:

  • LBBAP demonstrated safety and efficacy in managing atrioventricular block in this patient cohort.
  • This contrasts with right ventricular pacing, which can worsen heart failure.
  • LBBAP appears to be a viable alternative to biventricular pacing, with potentially lower risks.

Implications:

  • LBBAP represents a promising pacing strategy for transthyretin cardiac amyloidosis patients with conduction abnormalities.
  • Further research is warranted to establish LBBAP as a standard treatment.
  • This approach may improve outcomes and reduce heart failure progression in affected individuals.
Abstract

Keywords:
Atrioventricular blockCase seriesHeart failureLeft bundle branch area pacingPhysiological pacingTransthyretin cardiac amyloidosisVentricular septal hypertrophy

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