Atrial and ventricular arrhythmias in patients with cardiac amyloidosis: Incidence, risk factors, and prognostic

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Isolation of Atrial Myocytes from Adult Mice
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Jason Z Li1, Connor P Oates2, Meredith Njus1

  • 1MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA; MedStar Georgetown University Hospital, Washington, DC, USA.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|April 12, 2025
PubMed

Insights

Arrhythmias are common in cardiac amyloidosis (CA), particularly atrial fibrillation and flutter in ATTR-CA. Sustained ventricular tachycardia in CA increases mortality risk, but implantable cardioverter-defibrillator (ICD) therapy did not improve survival.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiovascular Disease

Background:

  • Cardiac amyloidosis (CA) poses significant risks for arrhythmias, with poorly understood prognostic implications.
  • The role of implantable cardioverter-defibrillators (ICDs) in managing CA-related arrhythmias remains unclear.

Purpose of the Study:

  • To investigate the risk factors, prognostic implications, and outcomes of arrhythmias in patients with cardiac amyloidosis.
  • To evaluate the effectiveness of ICD therapy in patients with CA.

Main Methods:

  • A retrospective analysis of 186 patients diagnosed with or referred for cardiac amyloidosis between February 2010 and April 2023.
  • Assessment of arrhythmia incidence, risk factors for ventricular tachycardia, and survival outcomes in relation to ICD implantation.

Main Results:

  • Atrial fibrillation (61.8%) and atrial flutter (24.7%) were common, especially in ATTR-CA. Sustained ventricular tachycardia (VT) occurred in 6.5% of CA patients.
  • QRS duration >120 ms and increased left ventricular end-diastolic diameter were associated with VT development.
  • Sustained VT independently predicted increased mortality, while ICD implantation did not significantly improve survival.

Conclusions:

  • Atrial and ventricular arrhythmias are prevalent in cardiac amyloidosis.
  • Adverse electrical and structural remodeling contribute to sustained VT, a significant predictor of mortality in CA.
  • Current evidence suggests ICD therapy may not improve survival in this patient population.
Abstract

Keywords:
Atrial fibrillationAtrial flutterCardiac amyloidosisImplantable cardioverter defibrillatorVentricular tachycardia

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