Prophylactic implantation of cardioverter-defibrillator in patients with severe cardiac amyloidosis and high risk for sudden cardiac death

• Verfasst von: Kristen, Arnt [VerfasserIn]
• Verfasst von: Dengler, Thomas [VerfasserIn]
• Verfasst von: Hegenbart, Ute [VerfasserIn]
• Verfasst von: Schönland, Stefan [VerfasserIn]
• Verfasst von: Goldschmidt, Hartmut [VerfasserIn]
• Verfasst von: Sack, Falk-Udo [VerfasserIn]
• Verfasst von: Voss, Frederik [VerfasserIn]
• Verfasst von: Becker, Rüdiger [VerfasserIn]
• Verfasst von: Katus, Hugo [VerfasserIn]
• Verfasst von: Bauer, Alexander [VerfasserIn]
• Titel: Prophylactic implantation of cardioverter-defibrillator in patients with severe cardiac amyloidosis and high risk for sudden cardiac death
• Verf.angabe: Arnt V. Kristen, Thomas J. Dengler, Ute Hegenbart, Stefan O. Schonland, Hartmut Goldschmidt, Falk-Udo Sack, Frederik Voss, Rüdiger Becker, Hugo A. Katus, Alexander Bauer
• E-Jahr: 2008
• Jahr: [February 2008]
• Umfang: 6 S.
• Illustrationen: 1 Diagramm
• Fussnoten: Gesehen am 21.01.2022
• Titel Quelle: Enthalten in: Heart rhythm
• Ort Quelle: New York, NY [u.a.] : Elsevier, 2004
• Jahr Quelle: 2008
• Band/Heft Quelle: 5(2008), 2, Seite 235-240
• ISSN Quelle: 1556-3871
• DOI: doi:10.1016/j.hrthm.2007.10.016
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Amyloid
• Sach-SW: Heart failure
• Sach-SW: Implantable cardioverter-defibrillator
• Sach-SW: Sudden death
• Sach-SW: Survival
• K10plus-PPN: 1786859084

Abstract

Background - Cardiac light-chain amyloidosis carries a high risk for death predominantly from progressive cardiomyopathy or sudden death (SCD). Independent risk factors for SCD are syncope and complex nonsustained ventricular arrhythmias. - Objective - The purpose of this study was to test whether prophylactic placement of an implantable cardioverter-defibrillator (ICD) reduces SCD in patients with cardiac amyloidosis. - Methods - Nineteen patients with histologically proven cardiac amyloidosis and a history of syncope and/or ventricular extra beats (Lown grade IVa or higher) received an ICD. - Results - During a mean follow-up of 811 ± 151 days, two patients with sustained ventricular tachyarrhythmias were successfully treated by the ICD. Two patients underwent heart transplantation, and seven patients died due to electromechanical dissociation (n = 6) or glioblastoma (n = 1). Nonsurvivors more often showed progression of left ventricular wall thickness, low-voltage pattern, ventricular arrhythmias (Lown grade IVa or higher), and higher N-terminal pro-brain natriuretic peptide levels than did survivors. Bradycardias requiring ventricular pacing (VVI 40/min <1%, DDD 60/min 6% ± 1%) occurred only rarely. - Conclusion - Patients with cardiac amyloidosis predominantly die as a result of electromechanical dissociation and other diagnoses not amenable to ICD therapy. Selected patients with cardiac amyloidosis may benefit from ICD placement. Better predictors of arrhythmia-associated SCD and randomized trials are required to elucidate the impact of ICD placement in high-risk patients with cardiac amyloidosis.