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Electrocardiographic Patterns and Arrhythmias in Cardiac Amyloidosis: From Diagnosis to Therapeutic Management-A
Lucio Teresi1,2, Giancarlo Trimarchi1,3, Paolo Liotta1
1Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy.
Insights
Cardiac amyloidosis (CA) affects heart electrical activity, causing common ECG changes like low voltages and poor R-wave progression. Arrhythmias, particularly atrial fibrillation, are frequent and require careful management in CA patients.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Electrophysiology
Background:
- Electrophysiological aspects of cardiac amyloidosis (CA) are underexplored.
- Electrocardiogram (ECG) abnormalities are vital for CA diagnosis, prognosis, and arrhythmia management.
- Common ECG findings include low voltages and pseudonecrosis patterns, aiding diagnosis and risk stratification.
Purpose of the Study:
- To explore the electrophysiological aspects of cardiac amyloidosis.
- To highlight the diagnostic and prognostic significance of ECG abnormalities in CA.
- To discuss the management of arrhythmias in CA, particularly transthyretin amyloidosis (ATTR).
Main Methods:
- Review of existing literature on ECG findings in CA.
- Analysis of arrhythmia prevalence and prognostic implications in CA patients.
- Discussion of current treatment strategies for arrhythmias in CA.
Main Results:
- Low voltages and poor R-wave progression are common ECG findings in CA.
- Ventricular and supraventricular arrhythmias, especially atrial fibrillation (AF) in ATTR, are prevalent and linked to disease progression.
- Conduction disturbances and bradyarrhythmias necessitate pacemaker implantation in up to 40% of patients.
Conclusions:
- ECG abnormalities are crucial for CA diagnosis, risk stratification, and management.
- Arrhythmias, including AF, are common in CA and require specific management considerations, such as anticoagulation.
- Pacemaker implantation is frequently required for conduction disturbances in CA patients.
Abstract:
Electrophysiological aspects of cardiac amyloidosis (CA) are still poorly explored compared to other aspects of the disease. However, electrocardiogram (ECG) abnormalities play an important role in CA diagnosis and prognosis and the management of arrhythmias is a crucial part of CA treatment. Low voltages and a pseudonecrosis pattern with poor R-wave progression in precordial leads are especially common findings. These are useful for CA diagnosis and risk stratification, especially when combined with clinical or echocardiographic findings. Both ventricular and supraventricular arrhythmias are common in CA, especially in transthyretin amyloidosis (ATTR), and their prevalence is related to disease progression. Sustained and non-sustained ventricular tachycardias' prognostic role is still debated, and, to date, there is a lack of specific indications for implantable cardiac defibrillator (ICD). On the other hand, atrial fibrillation (AF) is the most common supraventricular arrhythmia with a prevalence of up to 88% of ATTR patients. Anticoagulation should be considered irrespective of CHADsVA score. Furthermore, even if AF seems to not be an independent prognostic factor in CA, its treatment for symptom control is still crucial. Finally, conduction disturbances and bradyarrhythmias are also common, requiring pacemaker implantation in up to 40% of patients.
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