Atrial and ventricular arrhythmias in patients with cardiac amyloidosis: Incidence, risk factors, and prognostic implications.

BACKGROUND

The risk factors for developing arrhythmias, prognostic implications, and value of implantable cardioverter defibrillators (ICD) are poorly understood in patients with cardiac amyloidosis (CA).

METHODS

A single-center retrospective analysis was performed of consecutive patients diagnosed with or referred for cardiac amyloidosis at our center from 2/2010-4/2023.

RESULTS

A total of 186 patients were diagnosed with CA (AL-CA: 18.3%; ATTR-CA: 81.2%). Atrial fibrillation (AF) occurred in 61.8%, atrial flutter (AFL) in 24.7%, and sustained ventricular tachycardia (VT) in 6.5% of patients with CA. AF and AFL occurred more commonly in patients with ATTR-CA than AL-CA (AF: 66.9% vs 38.2%; p = 0.002; AFL: 28.5% vs 8.8%; p = 0.017). On univariate analysis, QRS duration >120 ms (OR 4.22; 95% CI 1.21-14.64; p = 0.023) and left ventricular end diastolic diameter (OR 3.94; 95% CI 1.45-10.66; p = 0.007) were associated with the development of sustained VT in patients with CA. Incidence of sustained VT in patients with CA was independently associated with increased risk of mortality (HR 2.22; 95% CI 1.10-4.50; p = 0.027), however, ICD implantation was not associated with improved survival (HR 0.59; 95% CI 0.32-1.08; p = 0.090).

CONCLUSION

Atrial and ventricular arrhythmias are common in CA. Characteristics of adverse electrical and structural remodeling are associated with the development of sustained VT, which was independently associated with increased mortality in this population. ICD therapy was not associated with improved survival.