High-grade isolated atrial amyloidosis was associated with a significantly higher rate of atrial tachyarrhythmias compared to absent or trivial amyloid deposits (72% vs 31%; p=0.03).
Observational (n=27)
Is high-grade isolated atrial amyloidosis associated with an increased prevalence of atrial tachyarrhythmias compared to absent or trivial amyloidosis?
High-grade isolated atrial amyloidosis is significantly associated with a higher prevalence of premortem atrial tachyarrhythmias compared to absent or trivial amyloid deposits.
Absolute Event Rate: 72% vs 31%
p-value: p=0.03
OBJECTIVE: Isolated atrial amyloidosis (IAA) is associated with atrial tachyarrhythmias. However, only a few studies have appraised atrial tachyarrhythmias and atrial depolarization abnormalities in connection with high-grade IAA. We conducted a collaborative retrospective study to assess this association. METHODS: One hundred consecutive autopsied hearts were studied histologically for IAA. To increase the specificity for atrial depolarization abnormalities in this preliminary study, we excluded those specimens with intermediate amyloid involvement, i.e. IAA grades 1 and 2 (grade 0 = absent or trivial deposits; grade 1 = small deposits; grade 2 = moderate deposits; grade 3 = dense, large deposits). We then screened for baseline, premortem electrocardiograms (ECGs) to assess rhythm. In those with sinus rhythm, the P wave axis, duration, dispersion and terminal force in V1 were determined under magnification. RESULTS: Of the 27 premortem ECGs corresponding to the autopsy specimens with grades 3 (sample) or 0 (controls) IAA, 9 showed sinus rhythm, 13 showed atrial fibrillation, 1 showed atrial flutter and 4 were uninterpretable. Fourteen autopsied hearts (52%) were positive for grade 3 IAA. Ten of those had atrial tachyarrhythmias (9 atrial fibrillation and 1 atrial flutter) compared to 4 of the 13 hearts with grade 0 IAA (72 vs. 31%, respectively; p = 0.03). Although there was excellent interobserver agreement using intraclass correlation coefficients, there were no significant differences in P wave measurements among the small number of patients with sinus rhythm for grade 3 versus grade 0 IAA. CONCLUSION: In a collaborative, preliminary, pilot assessment of autopsied hearts for which premortem ECGs were necessarily screened retrospectively, significantly more hearts with high-grade IAA were associated with atrial tachyarrhythmias compared to those with low-grade IAA. A larger study with an appropriately matched autopsy control group is needed to confirm these and previous observations.
Ariyarajah et al. (Thu,) conducted a observational in Isolated atrial amyloidosis (n=27). High-grade (grade 3) isolated atrial amyloidosis vs. Low-grade (grade 0) isolated atrial amyloidosis was evaluated on Atrial tachyarrhythmias (p=0.03). High-grade isolated atrial amyloidosis was associated with a significantly higher rate of atrial tachyarrhythmias compared to absent or trivial amyloid deposits (72% vs 31%; p=0.03).