{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T10:05:51Z","timestamp":1789034751759,"version":"build-2803163510"},"reference-count":23,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T00:00:00Z","timestamp":1767139200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Transthyretin cardiomyopathy (ATTR-CM) is frequently associated with conduction disease requiring pacing. Conventional right ventricular pacing may worsen cardiac function, whereas left bundle branch area pacing (LBBAP) aims to preserve physiological activation. Evidence for LBBAP in ATTR-CM remains limited. Methods: A structured narrative review of PubMed and Google Scholar was performed through November 2025 using predefined terms related to LBBAP and ATTR-CM. Peer-reviewed articles, case reports, case series, and relevant abstracts were included. Studies exclusively on light-chain cardiac amyloidosis were excluded. Results: Ten publications met inclusion criteria, comprising three case reports, five case series, one retrospective cohort without a comparator, and one cohort comparing LBBAP with cardiac resynchronization therapy (CRT). In total, 56 patients with ATTR-CM underwent LBBAP. Implantation success was high, with stable acute and mid-term electrical parameters. Follow-up (typically 3\u201312 months) showed stable electrical parameters with narrow paced QRS complexes and preserved or improved left ventricular ejection fraction in most reports. Symptomatic improvement and reductions in natriuretic peptides were variably described. No major lead-related complications were reported. Comparative data remain sparse and inconclusive. Conclusions: This review suggests that LBBAP is a feasible and safe pacing approach in patients with ATTR-CM and may help to stabilize or improve heart failure symptoms. Further prospective studies are needed to confirm its clinical effectiveness.<\/jats:p>","DOI":"10.3390\/jcm15010305","type":"journal-article","created":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T15:05:01Z","timestamp":1767193501000},"page":"305","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Left Bundle Branch Area Pacing in Transthyretin Cardiac Amyloidosis: A Narrative Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5665-5759","authenticated-orcid":false,"given":"Maria","family":"Herrera Bethencourt","sequence":"first","affiliation":[{"name":"Department of Cardiology, CHU Martinique (University Hospital of Martinique), 97200 Fort de France, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7657-3700","authenticated-orcid":false,"given":"Arnt V.","family":"Kristen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology, Respiratory Medicine, Medical University of Heidelberg, 69120 Heidelberg, Germany"},{"name":"Cardiovascular Center Darmstadt, 64287 Darmstadt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5971-1235","authenticated-orcid":false,"given":"Vincent","family":"Algalarrondo","sequence":"additional","affiliation":[{"name":"Service de Cardiologie, H\u00f4pital Bichat, Unit\u00e9 de Rythmologie Centre de Reference Amylose CERAMIC-CARDIO, 46 rue Henri Huchard, 75018 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2839-4454","authenticated-orcid":false,"given":"Guram","family":"Imnadze","sequence":"additional","affiliation":[{"name":"Department of Rhythmology, University Hospital Ruppin-Brandenburg, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0748-0302","authenticated-orcid":false,"given":"Andreas","family":"M\u00fcssigbrodt","sequence":"additional","affiliation":[{"name":"Department of Cardiology, CHU Martinique (University Hospital of Martinique), 97200 Fort de France, France"},{"name":"Faculty of Medicine, University of Leipzig, 04103 Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.1161\/CIR.0000000000000792","article-title":"Cardiac Amyloidosis: Evolving Diagnosis and Management: A Scientific Statement From the American Heart Association","volume":"142","author":"Kittleson","year":"2020","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Mvita Bakatubia, C., Vergier, R., Simeon, M., Buila Bimbi, N., Malka, N., Lounaci, K., Herrera Bethencourt, M., Fard, K., Kristen, A., and Banydeen, R. (2025). Thoracic Fat Pad Biopsy in Cardiac Amyloidosis: Diagnostic Yield in an Afro-Caribbean Population. J. Clin. Med., 14.","DOI":"10.3390\/jcm14051677"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"171","DOI":"10.3109\/13506129.2015.1051219","article-title":"Prevalence of the Amyloidogenic Transthyretin (TTR) V122I Allele in 14 333 African\u2013Americans","volume":"22","author":"Jacobson","year":"2015","journal-title":"Amyloid"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1007\/s00392-019-01490-2","article-title":"When and How Do Patients with Cardiac Amyloidosis Die?","volume":"109","author":"Escher","year":"2020","journal-title":"Clin. Res. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.tcm.2023.02.004","article-title":"Conduction System Disease in Cardiac Amyloidosis","volume":"34","author":"Assaf","year":"2024","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.acvd.2024.10.323","article-title":"Management of Conduction Disease and Arrhythmias in Patients with Cardiac Amyloidosis: A Position Paper from the Working Group of Cardiac Pacing and Electrophysiology of the French Society of Cardiology","volume":"118","author":"Lellouche","year":"2025","journal-title":"Arch. Cardiovasc. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Dobner, S., Zarro, S., Wieser, F., Kassar, M., Alaour, B., Wiedemann, S., Bakula, A., Caobelli, F., Stortecky, S., and Gr\u00e4ni, C. (2024). Effect of Timely Availability of TTR-Stabilizing Therapy on Diagnosis, Therapy, and Clinical Outcomes in ATTR-CM. J. Clin. Med., 13.","DOI":"10.20944\/preprints202408.1418.v1"},{"key":"ref_8","first-page":"71","article-title":"2021 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy","volume":"24","author":"Glikson","year":"2022","journal-title":"EP Eur."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1093\/europace\/euad043","article-title":"EHRA Clinical Consensus Statement on Conduction System Pacing Implantation: Endorsed by the Asia Pacific Heart Rhythm Society (APHRS), Canadian Heart Rhythm Society (CHRS), and Latin American Heart Rhythm Society (LAHRS)","volume":"25","author":"Burri","year":"2023","journal-title":"Europace"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1007\/s10741-024-10469-9","article-title":"Conduction System Pacing in Heart Failure: Time for a Paradigm Shift?","volume":"30","author":"Vlachakis","year":"2024","journal-title":"Heart Fail. Rev."},{"key":"ref_11","first-page":"149","article-title":"Feasibility and Safety of Left Bundle Branch Area Pacing in Cardiac Amyloidosis. A Single Center Experience","volume":"47","year":"2023","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1016\/j.jaccas.2020.04.040","article-title":"Left Bundle Branch Pacing in Transthyretin Cardiac Amyloidosis and Alternating Bundle Branch Block","volume":"2","author":"Ahmed","year":"2020","journal-title":"JACC Case Rep."},{"key":"ref_13","first-page":"182","article-title":"Initial Experience with Left Bundle Branch Area Pacing in Patients with Transthyretin Cardiac Amyloidosis","volume":"75","year":"2022","journal-title":"Rev. Esp. Cardiol. Engl. Ed."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e107","DOI":"10.1093\/ehjci\/jead278","article-title":"Left Bundle Branch Area Pacing for Chronic Heart Failure with Transthyretin Cardiac Amyloidosis","volume":"25","author":"Sudo","year":"2024","journal-title":"Eur. Heart J.-Cardiovasc. Imaging"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e156","DOI":"10.1093\/ehjci\/jead331","article-title":"Impact of Left Bundle Branch Area Pacing-Optimized Cardiac Resynchronized Therapy for Transthyretin Cardiac Amyloidosis","volume":"25","author":"Sudo","year":"2024","journal-title":"Eur. Heart J.-Cardiovasc. Imaging"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"euae102.467","DOI":"10.1093\/europace\/euae102.467","article-title":"Left Bundle Branch Area Pacing in the Setting of Cardiac Amyloidosis: A Case Series","volume":"26","author":"Mirizzi","year":"2024","journal-title":"Europace"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"ytae677","DOI":"10.1093\/ehjcr\/ytae677","article-title":"Left Bundle Branch Area Pacing in Patients with Transthyretin Cardiac Amyloidosis: A Case Series","volume":"9","author":"Miyajima","year":"2024","journal-title":"Eur. Heart J.-Case Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"S657","DOI":"10.1016\/j.hrthm.2025.03.1605","article-title":"PO-06-057 left bundle area pacing in patients with cardiac amyloidosis","volume":"22","author":"Trongtorsak","year":"2025","journal-title":"Heart Rhythm"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1016\/j.hrthm.2024.10.069","article-title":"Novel Technique and Assessment of Available 3-Dimensional Delivery Sheath for Endomyocardial Biopsy during Cardiac Device Implantation","volume":"22","author":"Sudo","year":"2025","journal-title":"Heart Rhythm"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.ipej.2025.01.001","article-title":"Conduction Disease in Cardiac Amyloidosis Patients: A Case Series Suggesting a Role for Left Bundle Branch Area Pacing","volume":"25","author":"Mehta","year":"2025","journal-title":"Indian Pacing Electrophysiol. J."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Leventopoulos, G., Nastouli, K.-M., Bozika, M., Papastavrou, E., Apostolos, A., Koros, R., Perperis, A., Koniari, I., Vlassopoulou, N., and Chronopoulos, P. (2025). Understanding LOT-CRT: Current Insights, Limitations, and Our Center\u2019s Experience. J. Clin. Med., 14.","DOI":"10.3390\/jcm14093025"},{"key":"ref_22","first-page":"1736.e1","article-title":"A Novel Pacing Strategy With Low and Stable Output: Pacing the Left Bundle Branch Immediately Beyond the Conduction Block","volume":"33","author":"Huang","year":"2017","journal-title":"Can. J. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1111\/pace.13989","article-title":"Autopsy Evaluation of the Implantation Site of a His Bundle Pacing Lead Demonstrating Selective Capture","volume":"43","author":"Kato","year":"2020","journal-title":"Pacing Clin. Electrophysiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/1\/305\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T15:25:14Z","timestamp":1767194714000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/1\/305"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,31]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15010305"],"URL":"https:\/\/doi.org\/10.3390\/jcm15010305","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,31]]}}}