Arrhythmias and Device Therapies in Cardiac Amyloidosis
Cardiac amyloidosis is caused by amyloid fibrils that deposit in the myocardial interstitium, causing restrictive cardiomyopathy and eventually death. The electromechanical, inflammatory, and autonomic changes due to amyloid deposition result in arrhythmias. Atrial fibrillation is by far the most co...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-02-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/13/5/1300 |
| _version_ | 1797264271296430080 |
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| author | Syed Bukhari Syed Zamrak Khan Mohamed Ghoweba Bilal Khan Zubair Bashir |
| author_facet | Syed Bukhari Syed Zamrak Khan Mohamed Ghoweba Bilal Khan Zubair Bashir |
| author_sort | Syed Bukhari |
| collection | DOAJ |
| description | Cardiac amyloidosis is caused by amyloid fibrils that deposit in the myocardial interstitium, causing restrictive cardiomyopathy and eventually death. The electromechanical, inflammatory, and autonomic changes due to amyloid deposition result in arrhythmias. Atrial fibrillation is by far the most common arrhythmia. The rate control strategy is generally poorly tolerated due to restrictive filling physiology and heart rate dependance, favoring adoption of the rhythm control strategy. Anticoagulation for stroke prophylaxis is warranted, irrespective of CHA<sub>2</sub>DS<sub>2</sub>-VASc score in patients with a favorable bleeding profile; data on left appendage closure devices are still insufficient. Ventricular arrhythmias are also not uncommon, and the role of implantable cardioverter-defibrillator in cardiac amyloidosis is controversial. There is no evidence of improvement in outcomes when used for primary prevention in these patients. Bradyarrhythmia is most commonly associated with sudden cardiac death in cardiac amyloidosis. Pacemaker implantation can help provide symptomatic relief but does not confer mortality benefit. |
| first_indexed | 2024-04-25T00:26:15Z |
| format | Article |
| id | doaj.art-01ba7b39a85b4f0d9bc5cd0ad54a16f8 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-04-25T00:26:15Z |
| publishDate | 2024-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-01ba7b39a85b4f0d9bc5cd0ad54a16f82024-03-12T16:47:54ZengMDPI AGJournal of Clinical Medicine2077-03832024-02-01135130010.3390/jcm13051300Arrhythmias and Device Therapies in Cardiac AmyloidosisSyed Bukhari0Syed Zamrak Khan1Mohamed Ghoweba2Bilal Khan3Zubair Bashir4Department of Cardiovascular Medicine, Section of Vascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USADepartment of Cardiovascular Medicine, Section of Vascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USADepartment of Cardiovascular Medicine, Section of Vascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USADepartment of Hospital Medicine, Temple University-Jeanes Campus, Philadelphia, PA 19111, USADepartment of Hospital Medicine, Alpert Medical School of Brown University, Providence, RI 02903, USACardiac amyloidosis is caused by amyloid fibrils that deposit in the myocardial interstitium, causing restrictive cardiomyopathy and eventually death. The electromechanical, inflammatory, and autonomic changes due to amyloid deposition result in arrhythmias. Atrial fibrillation is by far the most common arrhythmia. The rate control strategy is generally poorly tolerated due to restrictive filling physiology and heart rate dependance, favoring adoption of the rhythm control strategy. Anticoagulation for stroke prophylaxis is warranted, irrespective of CHA<sub>2</sub>DS<sub>2</sub>-VASc score in patients with a favorable bleeding profile; data on left appendage closure devices are still insufficient. Ventricular arrhythmias are also not uncommon, and the role of implantable cardioverter-defibrillator in cardiac amyloidosis is controversial. There is no evidence of improvement in outcomes when used for primary prevention in these patients. Bradyarrhythmia is most commonly associated with sudden cardiac death in cardiac amyloidosis. Pacemaker implantation can help provide symptomatic relief but does not confer mortality benefit.https://www.mdpi.com/2077-0383/13/5/1300cardiac amyloidosisarrhythmialeft atrial appendage closure devicepacemakerimplantable cardioverter defibrillator |
| spellingShingle | Syed Bukhari Syed Zamrak Khan Mohamed Ghoweba Bilal Khan Zubair Bashir Arrhythmias and Device Therapies in Cardiac Amyloidosis Journal of Clinical Medicine cardiac amyloidosis arrhythmia left atrial appendage closure device pacemaker implantable cardioverter defibrillator |
| title | Arrhythmias and Device Therapies in Cardiac Amyloidosis |
| title_full | Arrhythmias and Device Therapies in Cardiac Amyloidosis |
| title_fullStr | Arrhythmias and Device Therapies in Cardiac Amyloidosis |
| title_full_unstemmed | Arrhythmias and Device Therapies in Cardiac Amyloidosis |
| title_short | Arrhythmias and Device Therapies in Cardiac Amyloidosis |
| title_sort | arrhythmias and device therapies in cardiac amyloidosis |
| topic | cardiac amyloidosis arrhythmia left atrial appendage closure device pacemaker implantable cardioverter defibrillator |
| url | https://www.mdpi.com/2077-0383/13/5/1300 |
| work_keys_str_mv | AT syedbukhari arrhythmiasanddevicetherapiesincardiacamyloidosis AT syedzamrakkhan arrhythmiasanddevicetherapiesincardiacamyloidosis AT mohamedghoweba arrhythmiasanddevicetherapiesincardiacamyloidosis AT bilalkhan arrhythmiasanddevicetherapiesincardiacamyloidosis AT zubairbashir arrhythmiasanddevicetherapiesincardiacamyloidosis |