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Use of Implantable Electronic Devices in Patients With Cardiac Amyloidosis
- Source :
- Canadian Journal of Cardiology. 36:408-415
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- Arrhythmias are a major cause of morbidity and mortality in the course of cardiac amyloidosis (CA). Less commonly, they may be the initial manifestation that lead to the diagnosis. With improved therapeutic interventions for amyloidosis, it is no longer considered to be a terminal untreatable condition, and there is increasing recognition of the role of implantable electronic devices in CA. The frequency and nature of arrhythmias are largely determined by the type of amyloidosis. Bradyarrhythmias are more common in the transthyretin form of amyloidosis, and risk for ventricular arrhythmias is higher in the light-chain form. Pacemaker implantation is often required and effective for alleviation of symptoms. The role of implantable cardioverter-defibrillators (ICDs) remains controversial, especially for primary prevention of sudden death. Traditional risk stratification tools for sudden death do not appear to be applicable to CA, because decline of left ventricular (LV) systolic dysfunction to the point of the usual indication for an ICD implant in other cardiomyopathies, ie, LV ejection fraction ≤ 35%, usually marks end-stage disease in CA when pump failure becomes the predominant cause of death. The challenge remains the identification of markers for sudden death in early stages of the disease. Included in this review is a general overview of available data on the nature of bradycardia and ventricular arrhythmias, including the role of implantable electronic devices for the treatment of these conditions. Published series of ICD use in CA are summarized and the role of newer pacing techniques, including biventricular pacing, is discussed.
- Subjects :
- Bradycardia
medicine.medical_specialty
030204 cardiovascular system & hematology
Sudden death
Cardioverter-Defibrillator
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine
AL amyloidosis
Humans
030212 general & internal medicine
Cause of death
Ejection fraction
business.industry
Amyloidosis
Arrhythmias, Cardiac
medicine.disease
Defibrillators, Implantable
Cardiac amyloidosis
Cardiology
medicine.symptom
Cardiomyopathies
Cardiology and Cardiovascular Medicine
business
Algorithms
Subjects
Details
- ISSN :
- 0828282X
- Volume :
- 36
- Database :
- OpenAIRE
- Journal :
- Canadian Journal of Cardiology
- Accession number :
- edsair.doi.dedup.....f124636cad64bfa3a38d87b9b71a2fd8