Management of Rhythm and Conduction Disorders in Cardiac Amyloidosis: A French Nationwide Delphi Study

Cardiac amyloidosis (CA) is an increasingly recognized cardiomyopathy with an associated risk of arrhythmias and conduction disorders; however, managing arrhythmias and conductive disorders remains largely undefined.

This study aims to gather French expert experience on current practices and treatment strategies for managing arrhythmias and conduction disorders in CA. The main areas of interest included atrial fibrillation (AF) management, anticoagulation therapy, and criteria for implanting cardiac rhythm devices.

A modified Delphi method was employed, involving a panel of 56 cardiologists and electrophysiologists specializing in CA. The panel evaluated 248 statements over 2 rounds. Consensus was defined as agreement from at least 66.7% of the panel, with strong consensus requiring more than 50% complete agreement.

Consensus was achieved on 177 out of 248 statements across 2 rounds (71%). Key agreements included 1) the necessity for regular Holter monitoring and anticoagulation therapy in high-risk scenarios; 2) a rhythm control management strategy, including the use of amiodarone and AF ablation, particularly in the early stages of the disease; and 3) the use of cardiac devices for advanced conduction disorders, with decisions influenced by disease staging and left ventricular ejection fraction.

Approximately 70% of the proposed statements achieved agreement among the experts, reflecting reasonable alignment on anticoagulation therapy, AF management, and implantable cardiac devices. However, the study also highlights the need for personalized, multidisciplinary management of arrhythmias and conduction disorders in CA and emphasizes the need for future research to develop evidence-based guidelines.