Incidence and risk factors for pacemaker implantation in light‐chain and transthyretin cardiac amyloidosis

Porcari, Aldostefano; Rossi, Maddalena; Cappelli, Francesco; Canepa, Marco; Musumeci, Beatrice; Cipriani, Alberto; Tini, Giacomo; Barbati, Giulia; Varrà, Guerino Giuseppe; Morelli, Cristina; Fumagalli, Carlo; Zampieri, Mattia; Argirò, Alessia; Vianello, Pier Filippo; Sessarego, Eugenio; Russo, Domitilla; Sinigiani, Giulio; Michieli, Laura De; Bella, Gianluca Di; Autore, Camillo; Perfetto, Federico; Rapezzi, Claudio; Sinagra, Gianfranco; Merlo, Marco

doi:10.1002/ejhf.2533

Cited by 35 publications

(20 citation statements)

References 28 publications

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“…Among 405 consecutive patients with AL‐CA and ATTR‐CA, 36 (8.9%) patients underwent PM implantation during a median follow‐up of 33 months (interquartile range 21–46). The main factors leading to PM implantation were history of atrial fibrillation, PR interval >200 ms and QRS >120 ms at baseline electrocardiogram 17 …”

Section: Devicesmentioning

confidence: 99%

“…The main factors leading to PM implantation were history of atrial fibrillation, PR interval >200 ms and QRS >120 ms at baseline electrocardiogram. 17 Left ventricular assist device implantation has a major role in the treatment of the patients with advanced HF. 18 An analysis on 556 patients implanted in Europe from the PCHF-VAD registry shows the recent advances with this tool.…”

Section: Devicesmentioning

confidence: 99%

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July 2022 at a glance: focus on prognosis, devices and valvular heart disease

Tomasoni

Adamo

Metra

2022

European J of Heart Fail

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Section: Devicesmentioning

confidence: 99%

Section: Devicesmentioning

confidence: 99%

July 2022 at a glance: focus on prognosis, devices and valvular heart disease

Tomasoni

Adamo

Metra

2022

European J of Heart Fail

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“…In the study of Porcari et al ., 8 the incidence of PM implantation over a median follow‐up of 33 months is 8.9% (8.4% for AL‐CA, 3.4% for variant ATTR [ATTRv]‐CA and 10.6% for wild‐type [ATTRwt]‐CA). The prevalence, considering the patients with PM at baseline evaluation, was 8.9% (41 patients, 30 of them with ATTRwt, 8 with AL‐CA and 3 with ATTRv).…”

Section: What Is the Incidence Of Pacemaker Implantation In Cardiac A...mentioning

confidence: 99%

“…In this issue of the Journal, Porcari et al 8 . describe the incidence and risk factors for PM implantation in patients with CA, both transthyretin (ATTR)‐CA and AL‐CA.…”

mentioning

confidence: 99%

Predicting pacemaker implantation in cardiac amyloidosis: let's start with an ECG

Domínguez

2022

European J of Heart Fail

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This article refers to 'Incidence and risk factors for pacemaker implantation in light chain and transthyretin cardiac amyloidosis' by A. Porcari et al., published in this issue on pages 1227-1236.Cardiac amyloidosis (CA) has been a hot topic in cardiology in the last years. Some key factors that explain this burst of interest are the development of imaging techniques with high sensitivity and specificity that have increased the diagnostic capacity, as well as the arrival of targeted and effective treatments. 1,2 However, the key point for diagnosing CA is to think about it, so clinical suspicion remains crucial. CA is a disease of red flags, 3 and cardiac conduction disturbances that require pacemaker (PM) implantation have been one of the best-known for decades. 4 The most accepted pathophysiologic mechanism for cardiac conduction system disease in CA is the infiltration of the conduction system by misfolded proteins, 5 as well as fibrosis of the sinoatrial node and atrioventricular conduction network. 4 Another potential mechanism could be direct toxic effect of amyloid fibrils, especially in light-chain (AL)-CA. 6 Current European Society of Cardiology pacing and cardiac resynchronization therapy guidelines do not include a specific therapeutic approach in patients with CA. 7 However, they consider CA as one of the underlying structural heart diseases in which bradycardia and cardiac conduction disturbances are more frequent. Thus, it is important to identify those patients at risk who could benefit from a closer clinical follow-up or a different approach, even considering implantable loop recorders in patients at a very high risk of PM implantation.

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“…In addition, the non-invasive algorithm suffers from some limitations in real-world applications, as in patients with intense cardiac retention at scintigraphy and monoclonal gammopathy of undetermined significance requiring histological evidence of amyloid deposits or in the presence of false-negative scintigraphy results due to peculiar TTR mutations (i.e., Phe84Leu and Ser97Tyr) [9,10] . In this scenario, cardiac magnetic resonance and positron emission tomography can aid clinicians in the diagnosis and management of the disease, as discussed by Pica et al [13] and Genovesi et al [14] . Awareness of the pros and cons of each diagnostic strategy in CA is gaining increasing importance in daily activity, especially in light of treatment and prognostic implications [15] , as reviewed by Porcari et al [16] .…”

Section: Cardiac Amyloidosis: No More a Needle In A Haystackmentioning

confidence: 99%