Left Bundle Branch Area Pacing in Patients With Cardiac Sarcoidosis
Michael Gurin1, Michael Litt1, Tarek Zghaib1
1Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
JACC. Clinical Electrophysiology
|November 20, 2025
Summary
Left bundle branch area pacing (LBBAP) is a feasible option for cardiac sarcoidosis (CS) patients, showing stable lead performance. Further research is needed to confirm its clinical benefits, especially with septal involvement.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Sarcoidosis Research
Background:
- Left bundle branch area pacing (LBBAP) offers a physiological pacing alternative.
- Its efficacy in cardiac sarcoidosis (CS), characterized by septal inflammation/scarring, is not well-established.
Purpose of the Study:
- To evaluate the procedural success, lead performance, and clinical outcomes of LBBAP in CS patients.
- To assess the feasibility and safety of LBBAP in this specific patient population.
Main Methods:
- Retrospective study of CS patients undergoing LBBAP (Jan 2020-Mar 2024).
- CS diagnosis confirmed by Heart Rhythm Society criteria (histologic/imaging).
- Procedural metrics, device parameters, and echocardiographic data analyzed; LBBAP confirmed by EHRA criteria.
Main Results:
- Nineteen CS patients (mean age 59) underwent LBBAP, most commonly for atrioventricular block.
- Successful LBBAP in all patients with no acute complications; lead parameters remained stable over median 437-day follow-up.
- In a subgroup (n=4) with LBBB, prolonged QRS, and low LVEF, LVEF improved significantly (27% to 50%).
Conclusions:
- LBBAP is a feasible pacing strategy in cardiac sarcoidosis with stable long-term lead performance.
- Larger studies are required to determine the clinical benefit of LBBAP in CS, particularly concerning septal inflammation and fibrosis.
Related Concept Videos
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
378
Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
378
01:18Dysrhythmias IV: Characteristics of Bradyarrhythmias
481
Bradyarrhythmias are cardiac rhythm disorders characterized by a slower-than-normal heart rate, typically defined as fewer than 60 beats per minute. Some of which are discussed here:Sinus BradycardiaSinus bradycardia presents a heart rate lower than 60 beats per minute, with a regular rhythm originating from the SA node. The ECG typically shows normal P waves preceding each QRS complex, a normal PR interval (0.12 to 0.20 seconds), and a normal QRS duration (0.06 to 0.10 seconds).First-Degree AV...
481
01:30Cardiomyopathy II: Dilated Cardiomyopathy
449
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
449
01:29Cardiomyopathy IV: Restrictive Cardiomyopathy
432
Restrictive cardiomyopathy (RCM) is a rare heart muscle disease characterized by impaired ventricular filling due to stiffened ventricular walls, leading to significant diastolic dysfunction.EtiologyRestrictive cardiomyopathy can arise from both inherited and acquired diseases, many of which are systemic. It is categorized into four main types: infiltrative, storage, non-infiltrative, and endomyocardial diseases.Infiltrative diseases, such as amyloidosis, lead to RCM by depositing amyloid...
432