Journal article
Outcome and incidence of appropriate implantable cardioverter-defibrillator therapy in patients with cardiac amyloidosis
International journal of cardiology, Vol.222, pp.562-568
11/01/2016
DOI: 10.1016/j.ijcard.2016.07.254
PMID: 27513652
Abstract
Cardiac amyloidosis (CA) is associated with a poor prognosis with the proposed mechanism of sudden cardiac death in the majority of patients being pulseless electrical activity. However, the incidence of ventricular arrhythmias (VA) and implantable cardioverter-defibrillator (ICD) indications in CA patients are unclear.
We performed a detailed evaluation of our CA population undergoing ICD implantation and assessed appropriate ICD therapy and survival predictors.
We included consecutive patients from June 2008 to November 2014 in five centers. ICDs were systematically interrogated and clinical data recorded during follow-up.
Forty-five patients (35 males, mean age 66±12years) with CA who underwent ICD implantation (84.4% primary prevention) were included. CA types were hereditary transthyretin in 27 patients (60%), light chain (AL) in 12 (27%) and senile in 6 (13%). After a mean follow-up of 17±14months, 12 patients (27%) had at least 1 appropriate ICD therapy occurring after 4.7±6.6months. Patients with or without ICD therapy had no significant differences in baseline characteristics, amyloidosis type, LVEF, and type of prevention although there was a trend towards a better 2D global longitudinal strain in patients with ICD therapy (P=0.08). Over the follow-up, 12 patients died (27%) and 6 underwent cardiac transplantation (13%). From multivariate analysis a worse prognosis was associated with higher NT-proBNP level (>6800pg/mL, HR=5.5[1.7–17.8]) and AL type (HR=4.9[1.5–16.3]).
Appropriate ICD therapies are common (27%) in CA patients. No specific strong VA predictor could be identified. However, patients with advanced heart disease, especially with AL-CA, display a poorer outcome.
•Appropriate ICD therapies in CA patients are common (27% of the patients), regardless of CA and prevention types•Conventional selection criteria for ICD implantation in primary prevention (e.g. LVEF) are not suitable for CA patients.•Patients with an advanced form of CA, particularly the AL-CA type, had a very poor outcome despite ICD placement.•TTR-CA with early cardiac involvement and AL-CA awaiting cardiac transplant should be patients considered for an ICD.•Prospective studies are warranted to further investigate whether prophylactic ICD implantation would reduce mortality in CA.
Details
- Title: Subtitle
- Outcome and incidence of appropriate implantable cardioverter-defibrillator therapy in patients with cardiac amyloidosis
- Creators
- David Hamon - Hôpitaux Universitaires Henri MondorVincent Algalarrondo - Assistance Publique – Hôpitaux de ParisEstelle Gandjbakhch - Pitié-Salpêtrière HospitalFabrice Extramiana - Assistance Publique – Hôpitaux de ParisEloi Marijon - Assistance Publique – Hôpitaux de ParisNathalie Elbaz - Hôpitaux Universitaires Henri-MondorDounia Selhane - Hôpital Antoine-BéclèreJean-Luc Dubois-Rande - AP-HP, University Hospital Henri Mondor, Department of Cardiology, Creteil, FranceEmmanuel Teiger - Hôpitaux Universitaires Henri-MondorViolaine Plante-Bordeneuve - AP-HP, University Hospital Henri Mondor, Department of Neurology, Creteil, FranceThibaud Damy - InsermNicolas Lellouche - Hôpitaux Universitaires Henri-Mondor
- Resource Type
- Journal article
- Publication Details
- International journal of cardiology, Vol.222, pp.562-568
- Publisher
- Elsevier B.V
- DOI
- 10.1016/j.ijcard.2016.07.254
- PMID
- 27513652
- ISSN
- 0167-5273
- eISSN
- 1874-1754
- Language
- English
- Date published
- 11/01/2016
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984694748702771
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