Journal of electrocardiology · 2026
Electrocardiographic parameters and outcomes in patients with cardiac amyloidosis and implantable cardioverter defibrillators.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Lateef Azalfa, Seby Robert, Ma Yaohua, Malik Awais, Lyle Melissa, Munoz Freddy Del-Carpio, Gharacholou S Michael
Аннотация
BACKGROUND: Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy that can lead to various arrhythmias. Electrocardiogram (ECG) abnormalities have been reported in CA, though there is limited data on the prognostic significance of these findings.
METHODS: Between 1/1997 and 12/2019, we identified high arrhythmic-risk patients with CA who had clinically been treated with an implantable cardioverter defibrillator (ICD) to prevent sudden cardiac death from our multi-center practice. We studied baseline characteristics, comorbidities, echocardiograms, and ECG parameters. Regression models were used to evaluate the association of ECG characteristics with mortality or ICD shock while adjusting for baseline confounders.
RESULTS: We identified 44 patients with CA who had ICD implantation for prevention of sudden cardiac death. Baseline characteristics included 9 (20.5%) females, 19 (43.0%) with AL CA, and 4 (9.1%) who were non-white. The mean age was 65 ± 11 years in those with AL CA and 71 ± 10 years in those with transthyretin CA. Indications for ICD implantation include syncope in 3 (7.0%) patients, ventricular arrhythmias in 16 (37.2%) patients, and both syncope and ventricular arrhythmias in 2 (4.7%) patients. Overall, ICD implantation was performed for primary prevention in 26 (59.1%) patients and for secondary prevention in 18 (40.9%) patients. Low voltage QRS was noted in 8 (42.1%) of AL CA cohort (p = 0.07) and 6 (25%) of ATTR CA cohort had LBBB (p = 0.08). Bradycardia was more prevalent in ATTR CA than in AL CA. In unadjusted analysis, only age and reduced ejection fraction were associated with death or ICD shock. There were no ECG parameters associated with death or ICD shock.
CONCLUSIONS: In a high arrhythmic risk cohort of CA patients with ICDs, no specific ECG parameter was associated with increased all-cause mortality or ICD shock.
METHODS: Between 1/1997 and 12/2019, we identified high arrhythmic-risk patients with CA who had clinically been treated with an implantable cardioverter defibrillator (ICD) to prevent sudden cardiac death from our multi-center practice. We studied baseline characteristics, comorbidities, echocardiograms, and ECG parameters. Regression models were used to evaluate the association of ECG characteristics with mortality or ICD shock while adjusting for baseline confounders.
RESULTS: We identified 44 patients with CA who had ICD implantation for prevention of sudden cardiac death. Baseline characteristics included 9 (20.5%) females, 19 (43.0%) with AL CA, and 4 (9.1%) who were non-white. The mean age was 65 ± 11 years in those with AL CA and 71 ± 10 years in those with transthyretin CA. Indications for ICD implantation include syncope in 3 (7.0%) patients, ventricular arrhythmias in 16 (37.2%) patients, and both syncope and ventricular arrhythmias in 2 (4.7%) patients. Overall, ICD implantation was performed for primary prevention in 26 (59.1%) patients and for secondary prevention in 18 (40.9%) patients. Low voltage QRS was noted in 8 (42.1%) of AL CA cohort (p = 0.07) and 6 (25%) of ATTR CA cohort had LBBB (p = 0.08). Bradycardia was more prevalent in ATTR CA than in AL CA. In unadjusted analysis, only age and reduced ejection fraction were associated with death or ICD shock. There were no ECG parameters associated with death or ICD shock.
CONCLUSIONS: In a high arrhythmic risk cohort of CA patients with ICDs, no specific ECG parameter was associated with increased all-cause mortality or ICD shock.