Arrhythmia management in cardiac amyloidosis favors rhythm control and anticoagulation for atrial fibrillation, while ICDs and pacemakers offer no proven mortality benefit.
The review summarizes current evidence for managing arrhythmias in cardiac amyloidosis, emphasizing rhythm control for AF, universal anticoagulation for AF, and limited mortality benefit from device therapies.
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. Rate control strategy is generally poorly tolerated due to restrictive filling physiology and heart rate dependance, favoring adoption of rhythm control strategy. Anticoagulation for stroke prophylaxis is warranted irrespective of CHA2DS2Vasc score in patients with favorable bleeding profile; data on left appendage closure devices is 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.
Bukhari et al. (Wed,) conducted a review in Cardiac amyloidosis. Arrhythmia management and device therapies was evaluated. Arrhythmia management in cardiac amyloidosis favors rhythm control and anticoagulation for atrial fibrillation, while ICDs and pacemakers offer no proven mortality benefit.
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