Atrial fibrillation and subtype of atrial fibrillation in cardiac amyloidosis: clinical and echocardiographic features, impact on mortality

Sanchis, Kevin; Cariou, Eve; Colombat, Magali; Ribes, David; Huart, Antoine; Pascal, Pierre; Fournier, Pauline; Rollin, Anne; Carrié, Didier; Galinier, Michel; Maury, Philippe; Duparc, Alexandre; Lairez, Olivier

doi:10.1080/13506129.2019.1620724

Cited by 72 publications

(80 citation statements)

References 31 publications

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“…The salient findings of our study are as follows: AF is the most common arrhythmia in cardiac amyloidosis with a prevalence of up to 20%-60% in prior studies. 13,21,22 Our study in a larger subset of patients with CA found a prevalence of 25.4%. AF in CA patients can occur due to elevated left ventricular (LV) and atrial filling pressures secondary to LV diastolic dysfunction as a result of either amyloid fibril deposition within the myocardium or direct atrial myocardial toxicity from the amyloid deposition.…”

Section: Discussionmentioning

confidence: 67%

“…AF in CA patients can occur due to elevated left ventricular (LV) and atrial filling pressures secondary to LV diastolic dysfunction as a result of either amyloid fibril deposition within the myocardium or direct atrial myocardial toxicity from the amyloid deposition. 9,11 Previous studies have shown that the presence of AF does not have a significant impact on mortality in CA, 13,23 but can increase the risk of stroke, precipitate heart failure, or result in inappropriate therapies in patients being considered for ICD implantation. However, in a larger real-world population over 16 years, our study demonstrated that patients with AF were associated with increased short-term mortality (10.4% vs 6.5%, P < .0001).In our study, arrhythmias in patients admitted with F I G U R E 3 In-hospital Mortality by Arrhythmia type.…”

Section: Discussionmentioning

confidence: 99%

“…However, data are now emerging that the VAs may indeed have a role in sudden cardiac death (SCD) in CA (especially the AL variant) and patients may benefit from device therapy. 8,13,14 Furthermore, as therapies for CA improve, life-expectancy of these patients will undoubtedly improve.…”

Section: Introductionmentioning

confidence: 99%

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Trends, burden, and impact of arrhythmia on cardiac amyloid patients: A 16‐year nationwide study from 1999 to 2014

Isath

Correa²,

Siroky³

et al. 2020

Journal of Arrhythmia

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Background Patients with cardiac amyloidosis (CA) have increased mortality, which can be explained in part by an increased risk of arrhythmias. The burden of arrhythmias in CA, their predictors, and impact on in‐hospital outcomes remains unclear. The role of implantable cardioverter‐defibrillators (ICD) in this population is also uncertain. Methods We queried the National Inpatient Sample (NIS) using ICD‐9‐CM codes 277.39 and 425.7 to identify CA. Twelve common arrhythmias were extracted using appropriate, validated ICD‐9‐CM codes. ICD implantation was identified using procedure ICD‐9 codes 37.94 to 37.98, 00.51 and 00.54. Results There were a total of 145,920 CA hospitalizations between 1999 and 2014 in the United States and 56,199 (38.5%) of them were associated with arrhythmias. The prevalence of arrhythmias remained relatively constant from 41.5% in 1999 to 40.2% in 2014. The most common arrhythmia was atrial fibrillation (25.4%). In‐patient mortality was significantly higher in CA patients with arrhythmias (10.4% vs 6.5%, P < .001). ICD implantation was performed in 1,381 (0.94%) patients with CA and analysis revealed an incremental trend in implantation over the study period (0.48% in 1999 to 0.65% in 2014). In‐hospital mortality was significantly lower in patients who underwent ICD implantation (3.7% vs 8%; P = .0078). CA patients with arrhythmias also had an increased cost of hospitalization and length of stay ($65,046 ± 1,079 vs $53,322 ± 687 and 8.3 ± 0.1 vs 7.4 ± 0.1 days, respectively; P < .0001). Conclusion Cardiac arrhythmias are common in patients with CA and are associated with worse in‐hospital outcomes, increased length of stay, and cost of hospitalization.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

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Trends, burden, and impact of arrhythmia on cardiac amyloid patients: A 16‐year nationwide study from 1999 to 2014

Isath

Correa²,

Siroky³

et al. 2020

Journal of Arrhythmia

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“…Findings are very heterogeneous and include conduction disorders, tachycardias, as well as bradycardias [21]. Atrial fibrillation is common in CA and can be found in about 44-70% of patients with CA [22,23].…”

Section: Electrocardiogrammentioning

confidence: 99%

Diagnosis and supportive therapeutic management of cardiac light chain amyloidosis—a cardiologist’s perspective

Binder

Duca

2021

memo

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SummaryCardiac amyloidosis is caused by deposition of abnormally folded proteins (amyloid). The most common forms of amyloidosis which present with cardiac involvement are light-chain amyloidosis (AL) and transthyretin amyloidosis (ATTR). Even with novel treatments emerging, the prognosis of these patients remains poor once amyloid deposits in the heart. Therefore, knowledge on clinical and imaging features of cardiac amyloidosis is crucial to make an early diagnosis and improve patient outcomes. This article reviews the most important diagnostic findings of cardiac amyloidosis and gives an overview on the therapeutic management of these patients, including supportive-, device- and disease-specific drug therapies focusing on AL amyloidosis.

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“…4 The resultant disruption of the cardiac conduction system in patients with CA predisposes to arrhythmias, with the most frequent identified as atrial fibrillation (45-65%) and less frequently, atrioventricular conduction delays (3.5%) and ventricular tachyarrhythmias (VT 9.9% and VF 0.7% respectively). 5,6 Literature however currently states the patients with AL CA have a higher propensity to develop arrhythmias. 3 There is currently a paucity of literature on the prognostic benefit of treatment of ventricular arrhythmias in CA.…”

Section: Introductionmentioning

confidence: 99%

Ventricular Arrhythmias in Cardiac Amyloidosis: A Review of Current Literature

Khanna

Cho

et al. 2020

Clin Med Insights Cardiol

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Cardiac Amyloidosis is an infiltrative cardiomyopathy which occurs secondary to deposition of mis-folded protein in the myocardium, with the two most common subtypes being AL amyloidosis and TTR amyloidosis. The pathogenesis of the disease is multifaceted and involves a variety of mechanisms including an inflammatory response cascade, oxidative stress and subsequent separation of myocyte fibrils. Cardiac Amyloidosis frequently results in congestive cardiac failure and arrhythmias, from a disruption in cardiac substrate with subsequent electro-mechanical remodelling. Disease progression is usually demonstrated by development of progressive pump failure, which may be seen with a high arrhythmic burden, usually portending a poor prognosis. There is a paucity of literature on the clinical implications of ventricular arrhythmias in the context of cardiac amyloidosis. The important diagnostic investigations for these patients include transthoracic echocardiography, cardiac magnetic resonance imaging and an electrophysiology study. Whilst there are no robust management guidelines, studies have indicated benefits from contemporary pharmacological therapy and case-by-case catheter ablation. There are novel directed therapies available for TTR amyloidosis that have shown to improve overall survival. The role of ICD therapy in cardiac amyloidosis is controversial, with benefits seen predominantly in early phases of the disease process. The only definitive surgical therapy includes heart transplantation, but is largely indicated for progressive decompensated heart failure (Figure 1). Further large-scale studies are required to better outline management paradigms for treating ventricular arrhythmias in cardiac amyloidosis.

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Atrial fibrillation and subtype of atrial fibrillation in cardiac amyloidosis: clinical and echocardiographic features, impact on mortality

Cited by 72 publications

References 31 publications

Trends, burden, and impact of arrhythmia on cardiac amyloid patients: A 16‐year nationwide study from 1999 to 2014

Trends, burden, and impact of arrhythmia on cardiac amyloid patients: A 16‐year nationwide study from 1999 to 2014

Diagnosis and supportive therapeutic management of cardiac light chain amyloidosis—a cardiologist’s perspective

Ventricular Arrhythmias in Cardiac Amyloidosis: A Review of Current Literature

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