Key result
Beta-blocker re-introduction triggers symptomatic high-grade AV block requiring pacing in wtATTR cardiac amyloidosis.
Why the study?
Amyloid cardiomyopathy is an important and often unrecognized cause of heart failure and rhythm disturbances in the elderly, with conduction disorders in wtATTR amyloid cardiomyopathy frequently requiring permanent antibradycardia pacing.
Case Report (n=1)
No
This case report highlights the high risk of severe conduction disturbances and symptomatic bradyarrhythmias in wild-type transthyretin cardiac amyloidosis, particularly with beta-blocker therapy, often necessitating permanent pacemaker implantation.
Answers are grounded in this paper and cite their sources.
Exercise caution with beta-blockers in wtATTR amyloidosis; this case leaves open prospective pacing trials.
Amyloid cardiomyopathy is an important and often unrecognized cause of heart failure and rhythm disturbances leading to syncope or presyncope, especially among the elderly population. For wtATTR amyloid cardiomyopathy, bradyarrhythmia is common, more often due to conduction disorders than sinus node disease itself, which may require the implantation of a permanent antibradycardia pacemaker. This paper presents 75-years old male, with the symptomatic second-degree AV block with a ventricular rate of 35/min, therefore indicating the need for the implantation of a permanent anti-bradycardia pacemaker. Pacemaker implantation can improve symptoms and prevent sudden death caused by severe bradycardia, providing an opportunity for optimal medical therapy of tachyarrhythmia, but not reducing mortality rate of cardiac amyloidosis.
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Scepanovic et al. (2026) conducted a case report in Wild-type transthyretin (wtATTR) amyloid cardiomyopathy with symptomatic second-degree AV block (n=1). Permanent antibradycardia pacemaker implantation was evaluated on Indication for permanent antibradycardia pacemaker due to symptomatic second-degree AV block. Beta-blocker re-introduction in a 75-year-old male with wtATTR cardiac amyloidosis caused symptomatic second-degree AV block (35/min), indicating permanent pacemaker implantation.
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