Prophylactic implantation of cardioverter-defibrillator in patients with severe cardiac amyloidosis and high risk for sudden cardiac death
Background - Cardiac light-chain amyloidosis carries a high risk for death predominantly from progressive cardiomyopathy or sudden death (SCD). Independent risk factors for SCD are syncope and complex nonsustained ventricular arrhythmias. - Objective - The purpose of this study was to test whether p...
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| Main Authors: | , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
[February 2008]
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| In: |
Heart rhythm
Year: 2008, Volume: 5, Issue: 2, Pages: 235-240 |
| ISSN: | 1556-3871 |
| DOI: | 10.1016/j.hrthm.2007.10.016 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.hrthm.2007.10.016 Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S1547527107010260 
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| Author Notes: | Arnt V. Kristen, Thomas J. Dengler, Ute Hegenbart, Stefan O. Schonland, Hartmut Goldschmidt, Falk-Udo Sack, Frederik Voss, Rüdiger Becker, Hugo A. Katus, Alexander Bauer |
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| 245 | 1 | 0 | |a Prophylactic implantation of cardioverter-defibrillator in patients with severe cardiac amyloidosis and high risk for sudden cardiac death |c Arnt V. Kristen, Thomas J. Dengler, Ute Hegenbart, Stefan O. Schonland, Hartmut Goldschmidt, Falk-Udo Sack, Frederik Voss, Rüdiger Becker, Hugo A. Katus, Alexander Bauer |
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| 520 | |a Background - Cardiac light-chain amyloidosis carries a high risk for death predominantly from progressive cardiomyopathy or sudden death (SCD). Independent risk factors for SCD are syncope and complex nonsustained ventricular arrhythmias. - Objective - The purpose of this study was to test whether prophylactic placement of an implantable cardioverter-defibrillator (ICD) reduces SCD in patients with cardiac amyloidosis. - Methods - Nineteen patients with histologically proven cardiac amyloidosis and a history of syncope and/or ventricular extra beats (Lown grade IVa or higher) received an ICD. - Results - During a mean follow-up of 811 ± 151 days, two patients with sustained ventricular tachyarrhythmias were successfully treated by the ICD. Two patients underwent heart transplantation, and seven patients died due to electromechanical dissociation (n = 6) or glioblastoma (n = 1). Nonsurvivors more often showed progression of left ventricular wall thickness, low-voltage pattern, ventricular arrhythmias (Lown grade IVa or higher), and higher N-terminal pro-brain natriuretic peptide levels than did survivors. Bradycardias requiring ventricular pacing (VVI 40/min <1%, DDD 60/min 6% ± 1%) occurred only rarely. - Conclusion - Patients with cardiac amyloidosis predominantly die as a result of electromechanical dissociation and other diagnoses not amenable to ICD therapy. Selected patients with cardiac amyloidosis may benefit from ICD placement. Better predictors of arrhythmia-associated SCD and randomized trials are required to elucidate the impact of ICD placement in high-risk patients with cardiac amyloidosis. | ||
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| 650 | 4 | |a Heart failure | |
| 650 | 4 | |a Implantable cardioverter-defibrillator | |
| 650 | 4 | |a Sudden death | |
| 650 | 4 | |a Survival | |
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