Arrhythmias in Cardiac Amyloidosis: Challenges in Risk Stratification and Treatment

Publication date: Available online 12 December 2019Source: Canadian Journal of CardiologyAuthor(s): Christopher C. Cheung, Thomas M. Roston, Jason G. Andrade, Matthew T. Bennett, Margot K. DavisAbstractCardiac amyloidosis occurs secondary to the deposition of insoluble protein fibrils in cardiac tissue leading to progressive myocardial dysfunction, clinical heart failure, and arrhythmia. In recent years, increasing awareness and improved screening have resulted in an increased prevalence of cardiac amyloidosis, with contemporary estimates reporting a prevalence of 18 to 55 cases per 100,000 person-years, and accounting for more than 13% of heart failure hospitalizations. The arrhythmic manifestations of cardiac amyloidosis can range from conduction system disease and bradyarrhythmias to atrial fibrillation and sudden cardiac death. Bradyarrhythmias and conduction system disease may occur secondary to amyloid infiltration, but the timing of pacemaker implantation remains unclear. When available, biventricular pacing should be considered in symptomatic patients, particularly in those expected receive a high burden of ventricular pacing (>40%). The management of atrial fibrillation can be challenging, as contemporary agents for rate and rhythm control may be poorly tolerated in patients with cardiac amyloidosis. Patients with cardiac amyloidosis also have a high rate of intracardiac thrombus, and should be anticoagulated in the presence of atrial fibrillation (irrespective of CH...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research