Revista espanola de cardiologia (English ed.) · 2026
Arrhythmias detected by implanted cardiac rhythm recorders in transthyretin cardiac amyloidosis.
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Aguilera-Agudo Cristina, Peiró-Aventín Belén, de Castro Daniel, Castro-Urda Víctor, Toquero-Ramos Jorge, Jaén Eusebio García-Izquierdo, Jiménez-Sánchez Diego, Veloza-Urrea Darwin, Lozano-Jiménez Sara, Domínguez Fernando, Fernández-Lozano Ignacio, García-Pavía Pablo, Gonzalez-Lopez Esther
Аннотация
INTRODUCTION AND OBJECTIVES: Arrhythmias are a common complication of transthyretin cardiac amyloidosis (ATTR-CM). We sought to characterize the prevalence, risk factors, and prognosis of arrhythmias in ATTR-CM using implantable loop recorders (ILRs).
METHODS: ILRs were implanted in 49 patients with ATTR-CM (84% male; median age, 73.2 [66.2-78.8] years; 71% wild-type, 51% with known atrial fibrillation [AF]). Factors associated with the development of AF or pacemaker implantation were analyzed, and clinical outcomes were compared with those of a contemporary cohort of patients with 125 ATTR-CM without an ILR.
RESULTS: During a median follow-up of 37.2 [26.6-41.1] months, an advanced conduction disorder (ACD) prompting pacemaker implantation was detected in 16 individuals (33%) and new-onset AF was detected in 17 patients (71% of those without previous AF). Patients with new-onset AF more frequently had wild-type ATTR-CM. Those who needed pacemaker implantation were older and had a higher prevalence of hypertension and right bundle branch block, and a longer PR interval. Compared with patients without an ILR, early detection of arrhythmias by ILR was not associated with a prognostic benefit in terms of survival (P = .57), reduction of syncope (P = 1), heart failure admissions (P = .34), or embolic events (P = .999).
CONCLUSIONS: Although a higher incidence of arrhythmias was identified through ILR monitoring in patients with ATTR-CM, no significant benefits were observed in terms of survival or other hard clinical endpoints. Significant differences were identified in patients who developed new-onset AF and ACD. These differences should be considered during the clinical follow-up of this population.
METHODS: ILRs were implanted in 49 patients with ATTR-CM (84% male; median age, 73.2 [66.2-78.8] years; 71% wild-type, 51% with known atrial fibrillation [AF]). Factors associated with the development of AF or pacemaker implantation were analyzed, and clinical outcomes were compared with those of a contemporary cohort of patients with 125 ATTR-CM without an ILR.
RESULTS: During a median follow-up of 37.2 [26.6-41.1] months, an advanced conduction disorder (ACD) prompting pacemaker implantation was detected in 16 individuals (33%) and new-onset AF was detected in 17 patients (71% of those without previous AF). Patients with new-onset AF more frequently had wild-type ATTR-CM. Those who needed pacemaker implantation were older and had a higher prevalence of hypertension and right bundle branch block, and a longer PR interval. Compared with patients without an ILR, early detection of arrhythmias by ILR was not associated with a prognostic benefit in terms of survival (P = .57), reduction of syncope (P = 1), heart failure admissions (P = .34), or embolic events (P = .999).
CONCLUSIONS: Although a higher incidence of arrhythmias was identified through ILR monitoring in patients with ATTR-CM, no significant benefits were observed in terms of survival or other hard clinical endpoints. Significant differences were identified in patients who developed new-onset AF and ACD. These differences should be considered during the clinical follow-up of this population.