Key result
Baseline bifascicular block linked to ~14-fold higher risk of permanent pacing in ATTR-CM.
Why the study?
Factors associated with future pacing device implantation and the necessity of prophylactic pacing or ICD implantation in transthyretin amyloid cardiomyopathy patients were unclear.
Observational (n=164)
No
Hazard Ratio: 13.7
p-value: p=0.019
In patients with transthyretin amyloid cardiomyopathy, bifascicular block strongly predicts the need for future pacing device implantation, whereas first-degree AV block does not justify prophylactic pacing.
AIMS: This study aimed to identify factors for attention leading to future pacing device implantation (PDI) and reveal the necessity of prophylactic PDI or implantable cardioverter-defibrillator (ICD) implantation in transthyretin amyloid cardiomyopathy (ATTR-CM) patients. METHODS AND RESULTS: This retrospective single-center observational study included consecutive 114 wild-type ATTR-CM (ATTRwt-CM) and 50 hereditary ATTR-CM (ATTRv-CM) patients, neither implanted with a pacing device nor fulfilling indications for PDI at diagnosis. As a study outcome, patient backgrounds were compared with and without future PDI, and the incidence of PDI in each conduction disturbance was examined. Furthermore, appropriate ICD therapies were investigated in all 19 patients with ICD implantation. PR-interval ≥220 msec, interventricular septum (IVS) thickness ≥16.9 mm, and bifascicular block were significantly associated with future PDI in ATTRwt-CM patients, and brain natriuretic peptide ≥35.7 pg/mL, IVS thickness ≥11.3 mm, and bifascicular block in ATTRv-CM patients. The incidence of subsequent PDI in patients with bifascicular block at diagnosis was significantly higher than that of normal atrioventricular (AV) conduction in both ATTRwt-CM [hazard ratio (HR): 13.70, P = 0.019] and ATTRv-CM (HR: 12.94, P = 0.002), whereas that of patients with first-degree AV block was neither (ATTRwt-CM: HR: 2.14, P = 0.511, ATTRv-CM: HR: 1.57, P = 0.701). Regarding ICD, only 2 of 16 ATTRwt-CM and 1 of 3 ATTRv-CM patients received appropriate anti-tachycardia pacing or shock therapy, under the number of intervals to detect for ventricular tachycardia of 16-32. CONCLUSIONS: According to our retrospective single-center observational study, prophylactic PDI did not require first-degree AV block in both ATTRwt-CM and ATTRv-CM patients, and prophylactic ICD implantation was also controversial in both ATTR-CM. Larger prospective, multi-center studies are necessary to confirm these results.
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Kawahara et al. (2023) conducted an observational in Transthyretin amyloid cardiomyopathy (ATTR-CM) (n=164). Bifascicular block vs. Normal atrioventricular (AV) conduction was evaluated on Subsequent pacing device implantation (PDI) (HR 13.70, p=0.019). Bifascicular block at diagnosis was significantly associated with subsequent pacing device implantation compared to normal AV conduction in ATTRwt-CM (HR 13.70, P=0.019) and ATTRv-CM (HR 12.94, P=0.002).
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