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Utilization and Prognosis of Cardiac Device Implantation in AL Versus ATTR Amyloidosis

Bilal Hussain1, Sanchit Duhan2, Khawaja Hassan Akhtar3

  • 1Division of Cardiology, University of Cincinnati, Cincinnati, Ohio, USA.

Pacing and Clinical Electrophysiology : PACE
|February 25, 2026
PubMed

Insights

Transthyretin amyloidosis (ATTR-AMD) shows higher cardiac device implantation (CDI) rates than light chain amyloidosis (AL-AMD). AL-AMD patients undergoing CDI face significantly higher in-hospital mortality, especially with pacemakers and defibrillators.

Area of Science:

  • Cardiology
  • Medical Devices
  • Amyloidosis Research

Background:

  • Cardiac amyloidosis, including light chain (AL) and transthyretin (ATTR) types, often necessitates cardiac device implantation (CDI) due to complications like heart failure and arrhythmias.
  • Existing research lacks clarity on the distinct CDI requirements and outcomes for AL-AMD versus ATTR-AMD patients.

Purpose of the Study:

  • To investigate and compare the characteristics and outcomes of cardiac device implantation (CDI) in patients with AL-AMD versus ATTR-AMD.
  • To identify differences in CDI rates and in-hospital mortality between these two forms of cardiac amyloidosis.

Main Methods:

  • A retrospective analysis of the National Inpatient Sample database from 2017-2020 was performed.
  • Weighted multivariate regression models were employed to analyze in-hospital mortality, adjusting for potential confounders.
  • Patients undergoing CDI were stratified based on underlying AL-AMD or ATTR-AMD diagnoses.

Main Results:

  • ATTR-AMD patients were older and had a higher male proportion compared to AL-AMD patients undergoing CDI.
  • The rate of CDI was significantly higher in ATTR-AMD (8.3%) than in AL-AMD (1.4%).
  • Underlying AL-AMD was associated with substantially higher in-hospital mortality following permanent pacemaker (PPM) and implantable cardioverter-defibrillator (ICD) implantation compared to ATTR-AMD.

Conclusions:

  • Transthyretin amyloidosis (ATTR-AMD) demonstrates a greater need for cardiac device implantation (CDI) compared to light chain amyloidosis (AL-AMD).
  • Light chain amyloidosis (AL-AMD) is linked to increased in-hospital mortality risk for patients receiving pacemakers and implantable cardioverter-defibrillators.
Abstract

Keywords:
AL amyloidosisATTR amyloidosisamyloidosis

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