Cardiac resynchronization therapy demonstrated superior survival compared to high right ventricular pacing burden (≥40%) in ATTR-CM patients (HR 3.03, p=0.005).
Cohort (n=105)
Does CRT or high RVP burden affect survival and heart failure rehospitalization compared to low RVP burden in patients with ATTR-CM requiring device implantation?
In patients with ATTR-CM requiring device implantation, high right ventricular pacing burden is associated with increased mortality and HF rehospitalization, whereas upfront CRT is associated with improved survival compared to high RVP.
Effect estimate: HR 3.03
p-value: p=0.005
BACKGROUND Transthyretin cardiac amyloidosis (ATTR-CM) frequently affects native conduction, necessitating permanent pacemaker (PPM), implantable cardioverter-defibrillator (ICD), or cardiac resynchronization therapy (CRT) implantation. This study characterizes right ventricular pacing (RVP) burden in ATTR-CM patients and evaluates its impact on left ventricular ejection fraction (LVEF), heart failure (HF) rehospitalization, and survival. METHODS Retrospective chart review of ATTR-CM patients requiring device implantation (4/2012-9/2022). Patients were categorized by pacing burden: low RVP (pacing burden <40%, N=31), high RVP (≥40%, N=38), and CRT (N=36). Fine-Gray models were used for survival analysis; incidence rate ratios (IRRs) evaluated HF rehospitalization. Models were adjusted for age, race, gender, National Amyloidosis Center (NAC) staging, initial LVEF, and atrial fibrillation. RESULTS A total of 105 patients with mean age 80±8 years, 75% male, 67% Caucasian, were followed up for median 3.1 (IQR: 1.3-4.9) years. NAC stage II/III were more prevalent in high RVP (65%) and CRT (80%) versus low RVP (55%). High RVP showed significantly increased HF rehospitalization versus low RVP (IRR 5.76, p<0.001). CRT had higher rehospitalization than low RVP (IRR 3.35, p<0.001) but similar to high RVP (IRR 1.72, p=0.106). High RVP demonstrated worse survival versus low RVP (HR 6.24, p<0.001). CRT showed better survival than high RVP (HR 3.03, p=0.005) with no difference versus low RVP. Independent mortality predictors included NAC Stage III (HR 4.81, p<0.001), atrial fibrillation (HR 2.01, p=0.028), and lower initial LVEF (HR 1.03, p=0.006). CONCLUSION High RVP burden is associated with increased HF rehospitalization and mortality in ATTR-CM. CRT implanted upfront demonstrated superior survival compared to high RVP, suggesting a benefit for ATTR-CM patients with high pacing needs and NAC stage II/III, warranting further investigation.
Huangら（Sat）は、トランスサイレチン心アミロイドーシス（ATTR-CM）におけるコホート研究を実施した（n=105）。心臓再同期療法（CRT）または高右心室ペーシング（RVP ≥40%）と低RVP（<40%）の比較が生存率（HR 3.03, p=0.005）において評価された。心臓再同期療法は、ATTR-CM患者において高右心室ペーシング（≥40%）に比べて優れた生存率を示した（HR 3.03, p=0.005）。