Mode of death and outcomes of implantable cardioverter defibrillators in transthyretin amyloid cardiomyopathy. (15th February 2022)

• Record Type: Journal Article
• Authors: Dale, Zack; Al-Rashdan, Lana; Elman, Miriam; Chandrashekar, Pranav; Heitner, Stephen B.; Nazer, Babak; Masri, Ahmad
• Is Part Of: International journal of cardiology. Volume 349(2022)
• Page Start: 99
• Page End: 102
• Publication Date: 2022-02-15
• Subjects: Transthyretin amyloidosis -- Cardiac amyloidosis -- Implantable cardioverter-defibrillator; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2021.11.057
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Introduction: Transthyretin cardiac amyloidosis (ATTR-CM) may associate with sudden cardiac death. We report on the mode of death and outcomes with implantable cardioverter defibrillators (ICDs) in a cohort with ATTR-CM. Methods: A single center observational cohort study of patients with ATTR-CM diagnosed between 2005 and 2019. ICD implant was at discretion of treating cardiologists. Medians are expressed with 25th, 75th percentiles. Results: Eighty-four patients with ATTR-CM (age 73.5 ± 9.7 years, 94% male, median follow-up 21.1 months (11.4–38.1). Nineteen patients (23%) underwent ICD implantation – 18 for primary and 1 for secondary prevention. In the primary prevention ICD group, 1 patient had 2 inappropriate shocks, 1 patient had appropriate ATP on 3 occasions. One patient (mixed ischemic cardiomyopathy and ATTR-CM) with secondary prevention ICD had 15 appropriate shocks in 3 episodes of VT storm. In patients without ICD, ambulatory monitoring review (14, 764 h) did not reveal sustained ventricular arrhythmia. Excluding the one patient with secondary prevention ICD, 5 (28%) in the primary prevention ICD group and 22 (34%) in the non-ICD group died, p = 0.14. Mode of death did not vary between both groups. Conclusions: Patients with ATTR-CM and primary prevention ICD infrequently receive appropriate device therapy without differing in mode of death, which was mainly related to progressive heart failure, compared to those without ICD. Highlights: Appropriate device therapy is uncommon with primary prevention ICD in ATTR-CM. Sustained ventricular arrhythmia was not detected with ambulatory monitoring of patients without ICD. ICD was not associated with lower mortality as compared with the group without ICD. Mode of death was similar with versus without ICD and was largely due to progressive heart failure.