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Conventional right ventricular pacing may aggravate cardiac function, while left bundle branch area pacing (LBBAP) is intended to preserve more physiological activation. This structured narrative review synthesized PubMed and Google Scholar evidence through November 2025, focusing on LBBAP in ATTR-CM and excluding light-chain amyloidosis only. 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Follow-up commonly showed stable electrical parameters with narrow paced QRS complexes, supporting feasibility of LBBAP in ATTR-CM.","Answer","https://schema.org",{"og:url":83,"og:type":117,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":119,"canonical":83},"index,follow",{"doc_id":121,"site_id":62},461384,1790789844,{"code":4,"msg":5,"data":124},{"doc_id":121,"user_id":125,"nickname":92,"user_avatar":126,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":127,"file_id":128,"file_url":129,"file_type":130,"file_size":131,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":52,"language":132,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":133,"faqs":134,"seo_title":135,"seo_description":67,"update_tm":136,"read_time":137,"preview_page_count":4},7421720224475,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Review  \nLeft Bundle Branch Area Pacing in Transthyretin Cardiac Amyloidosis: A Narrative Review  \nMaria Herrera Bethencourt 1, Arnt V. Kristen 2,3, Vincent Algalarrondo 4, Guram Imnadze 5 and Andreas Müssigbrodt 1,6, *  \nAcademic Editor: Daniele Masarone  \nReceived: 25 November 2025  \nRevised: 23 December 2025  \nAccepted: 28 December 2025  \nPublished: 31 December 2025  \nCopyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \n1 Department of Cardiology, CHU Martinique (University Hospital of Martinique),  \n97200 Fort de France, France; [maria.herrerabethencourt@chu-martinique.fr](maria.herrerabethencourt@chu-martinique.fr)  \n2 Department of Cardiology, Angiology, Respiratory Medicine, Medical University of Heidelberg,  \n69120 Heidelberg, Germany; kristen@kardio-darmstadt.de  \n3 Cardiovascular Center Darmstadt, 64287 Darmstadt, Germany  \n4 Service de Cardiologie, Hôpital Bichat, Unité de Rythmologie Centre de Reference Amylose CERAMIC-CARDIO, 46 rue Henri Huchard, 75018 Paris, France; [vincent.algalarrondo@aphp.fr](vincent.algalarrondo@aphp.fr)  \n[5](5 Department of Rhythmology)[ Department of Rhythmology](5 Department of Rhythmology), [University Hospital Ruppin-Brandenburg](University Hospital Ruppin-Brandenburg), [Brandenburg Medical School](Brandenburg Medical School)[ ](Brandenburg Medical School)Theodor Fontane, 16816 Neuruppin, Germany; [g.imnadze@ukrb.de](g.imnadze@ukrb.de)  \n6 Faculty of Medicine, University of Leipzig, 04103 Leipzig, Germany  \n* Correspondence: [andreas.muessigbrodt@gmail.com](andreas.muessigbrodt@gmail.com); Tel.: +596-596-55-20-00  \nAbstract  \nBackground/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 3–12 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.  \nKeywords: cardiac amyloidosis; ATTR; pacemaker; left bundle branch area pacing; LBBAP  \n1. Introduction  \nTransthyretin (ATTR) amyloidosis is a systemic disorder characterized by the misfolding of transthyretin protein and deposition of insoluble fibrils in body tissues, with a marked predilection for cardiac involvement (Figure 1) [1] . ATTR-cardiomyopathy (ATTRCM) includes a hereditary variant (ATTRv-CM), caused by pathogenic TTR mutations, and wild-type (ATTRwt-CM), an age-related form without genetic alteration. Both subtypes  \nlead to extracellular deposition of misfolded transthyretin fibrils and progressive ca","cbCaiaR5ST9CUAri","https://ap.wps.com/l/cbCaiaR5ST9CUAri","pdf",1697989,"English","# Abstract\n## Background/Objectives\n## Methods\n## Results\n## Conclusions\n# Introduction\n## ATTR-CM subtypes and clinical context\n## Diagnostic illustration and LBBAP rationale","[{\"question\":\"What outcomes were reported regarding electrical parameters and paced QRS complexes?\",\"answer\":\"Across included studies, implantation success was high and acute to mid-term electrical parameters were stable. Follow-up commonly showed stable electrical parameters with narrow paced QRS complexes, supporting feasibility of LBBAP in ATTR-CM.\"}]","Left Bundle Branch Area Pacing in Transthyretin Cardiac Amyloidosis - A Narrative Review | PDF",1790761474,25]