A recent study sparks debate: Can LBBAP be a viable option for cardiac sarcoidosis patients? The American College of Cardiology's journal JACC: Clinical Electrophysiology published a retrospective study on November 21st (https://www.jacc.org/doi/10.1016/j.jacep.2025.09.046) that delves into this question.
The study reveals that left bundle branch area pacing (LBBAP) is indeed feasible for patients with cardiac sarcoidosis (CS), offering stable long-term lead performance. This is a significant finding, but here's where it gets controversial: the study was conducted at a single center, and larger-scale research is required to fully understand the clinical advantages of LBBAP in the context of septal inflammation and fibrosis.
Researchers, led by Dr. Michael Gurin, analyzed data from CS patients who underwent LBBAP at a tertiary center between January 2020 and March 2024. They meticulously examined echocardiographic data, device parameters, and procedural metrics at baseline and follow-up, defining CS using the Heart Rhythm Society's criteria. The European Heart Rhythm Association's criteria confirmed the success of LBBAP.
The study included 19 patients (average age 59, with 21% female) who met the criteria, with atrioventricular block being the primary indication for most (58%). Positron emission tomography and cardiac magnetic resonance imaging revealed septal involvement in 61% and 53% of patients, respectively.
Remarkably, LBBAP was successful in every patient without any acute complications. The baseline-paced QRS duration was 139 ± 25 ms, with a mean threshold of 0.75 ± 0.26 V, an R-wave amplitude of 15.2 ± 6.3 mV, and impedance of 738 ± 208 Ω. These lead parameters remained consistent over a 437-day follow-up period, regardless of septal involvement. Four patients had QRS >130 ms and LVEF <50%, and those with LBB block saw an improvement in LVEF from 27% to 50% (p=0.06).
Dr. Gurin and his team emphasize the importance of advanced imaging in procedural planning, stating that it can lead to better patient selection and potentially improved long-term outcomes. They also acknowledge the need for further research to determine the ideal timing for conduction system pacing in CS and other inflammatory cardiomyopathies.
In an accompanying editorial comment (https://www.jacc.org/doi/10.1016/j.jacep.2025.10.010), Drs. Edoardo Bressi and Jordana Kron stress the importance of an integrated pacing-defibrillation strategy for this patient group. They suggest that ongoing research should focus on long-term outcomes, image-guided implantation, and the potential for LBBAP systems to offer physiological resynchronization and arrhythmic protection.
This study opens up a fascinating discussion on the potential of LBBAP in cardiac sarcoidosis. But is it the definitive answer? What are your thoughts on this innovative approach? Share your opinions in the comments, especially if you have insights into the long-term efficacy and potential risks of LBBAP in this complex patient population.
