Routine ambulatory heart rhythm monitoring for detection of atrial arrhythmias in transthyretin cardiac amyloidosis

Dale, Zack; Chandrashekar, Pranav; Al-Rashdan, Lana; Gill, Sajan; Elman, Miriam R.; Fischer, K; Nazer, Babak; Masri, Ahmad

doi:10.1016/j.ijcard.2022.04.045

Cited by 8 publications

(11 citation statements)

References 39 publications

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“…Of note, although thrombo-embolism can occur in CA patients without AF, there is evidence that in those who suffer from ischaemic stroke, this arrhythmia is frequently detected only after embolic events. 9 , 12 This finding asserts the importance of continuous monitoring and surveillance for AF in CA patients in sinus rhythm.…”

Section: Discussionmentioning

confidence: 80%

Use of transoesophageal echocardiography to detect and manage atrial thrombi in light-chain cardiac amyloidosis: a case report

Dang

Hoang

2023

European Heart Journal - Case Reports

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Background Increased intracardiac thrombus formation in light-chain cardiac amyloidosis (AL-CA) has been associated with thrombotic events such as stroke and high rates of mortality and morbidity. Case summary A 51-year-old man was admitted to the emergency department with a sudden change in consciousness. His emergency brain magnetic resonance imaging showed two foci of cerebral infarction on bilateral temporal lobes. His electrocardiogram displayed a normal sinus rhythm with low QRS voltage. Transthoracic echocardiography showed concentric thickened ventricles, dilatation of both atria, a left ventricular ejection fraction of 53% and a grade-three diastolic dysfunction. The bull-eye plot on speckle tracking echocardiography displayed a distinctive apical sparing pattern. Serum free immunoglobulin analysis showed increased lambda free light chains (295.59 milligrams/liter) with a reduced kappa/lambda ratio (0.08). Light-chain amyloidosis was subsequently confirmed by examining histology of the abdominal fat-pad tissue. On transesophageal echocardiography (TEE), an elongated static thrombus and a mobile bouncing oval thrombus were found on the left and right atrial appendages, respectively. Atrial thrombi were managed with a full dose of dabigatran of 150 milligrams twice daily, which achieved a total resolution after 2 months on follow-up TEE. Discussion Complicating intracardiac thrombosis has been considered one of the major contributions of death in cardiac amyloidosis. Transesophageal echocardiography should be established to aid in the detection and management of atrial thrombus in AL-CA.

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Section: Discussionmentioning

confidence: 80%

Use of transoesophageal echocardiography to detect and manage atrial thrombi in light-chain cardiac amyloidosis: a case report

Dang

Hoang

2023

European Heart Journal - Case Reports

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“…Given the high prevalence of arrhythmias in CA patients and their impact on morbidity and mortality, routine screening for AF and AFL is recommended in this population. Ambulatory monitoring, such as Holter monitoring or ambulatory monitors, can be used to screen for arrhythmias in CA patients [ 40 ]. Early detection and management of arrhythmias, including appropriate anticoagulation for those with AF/AFL, can help improve outcomes in CA patients [ 40 ].…”

Section: Prognostic Significance Of Arrhythmiasmentioning

confidence: 99%

Arrhythmias in Patients with Cardiac Amyloidosis: A Comprehensive Review on Clinical Management and Devices

Briasoulis

Kourek

Papamichail

et al. 2023

JCDD

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Cardiac amyloidosis (CA) is a rare but potentially life-threatening disease in which misfolded proteins accumulate in the cardiac wall tissue. Heart rhythm disorders in CA, including supraventricular arrhythmias, conduction system disturbances, or ventricular arrhythmias, play a major role in CA morbidity and mortality, and thus require supplementary management. Among them, AF is the most frequent arrhythmia during CA hospitalizations and is associated with significantly higher mortality, while ventricular arrhythmias are also common and are usually associated with poor prognosis. Early diagnosis of potential arrythmias could be performed through ECG, Holter monitoring, and/or electrophysiology study. Clinical management of these patients is quite significant, and it usually includes initiation of amiodarone and/or digoxin in patients with AF, potential electrical cardioversion, or ablation in specific patients with indication, as well as initiation of anticoagulants in all patients, independent of AF and CHADS-VASc score, for potential intracardiac thrombus. Moreover, identification of patients with conduction disorders that could benefit from prophylactic pacemaker implantation and/or CRT as well as identification of patients with life-threatening ventricular arrythmias that could benefit from ICD could both increase the survival rates of these patients and improve their quality of life.

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“…A proposed scheme for the follow-up of patients with CA suggests performing a yearly 24 h Holter electrocardiogram (ECG) [ 18 ]; this is based mainly on clinical practice, and an optimal follow-up scheme has yet to be defined. Almost half of patients manifest AF before the diagnosis of CA [ 11 ], while others might have later thromboembolic events without showing any previous symptoms [ 19 ]. In this context, patient monitoring with a prolonged Holter ECG or implantable loop recorders (ILRs) could be useful in the early identification of AF and, subsequently, in the prescription of anticoagulation.…”

Section: Atrial Arrhythmiasmentioning

confidence: 99%

Arrhythmic Burden in Cardiac Amyloidosis: What We Know and What We Do Not

et al. 2022

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Cardiac amyloidosis (CA), caused by the deposition of insoluble amyloid fibrils, impairs different cardiac structures, altering not only left ventricle (LV) systo-diastolic function but also atrial function and the conduction system. The consequences of the involvement of the cardiac electrical system deserve more attention, as well as the study of the underlying molecular mechanisms. This is an issue of considerable interest, given the conflicting data on the effectiveness of conventional antiarrhythmic strategies. Therefore, this review aims at summarizing the arrhythmic burden related to CA and the available evidence on antiarrhythmic treatment in this population.

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Routine ambulatory heart rhythm monitoring for detection of atrial arrhythmias in transthyretin cardiac amyloidosis

Cited by 8 publications

References 39 publications

Use of transoesophageal echocardiography to detect and manage atrial thrombi in light-chain cardiac amyloidosis: a case report

Use of transoesophageal echocardiography to detect and manage atrial thrombi in light-chain cardiac amyloidosis: a case report

Arrhythmias in Patients with Cardiac Amyloidosis: A Comprehensive Review on Clinical Management and Devices

Arrhythmic Burden in Cardiac Amyloidosis: What We Know and What We Do Not

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