Role of Endomyocardial Biopsy and Bachmann's Bundle Pacing for Sinus Node Dysfunction in Cardiac Amyloidosis
Koji Sudo1, Kenji Kuroki1, Chisa Asahina1
1Department of Cardiovascular Medicine, University of Yamanashi, Kofu, Japan.
Insights
Bachmann's bundle (BB) pacing is a safe and effective treatment for patients with light-chain cardiac amyloidosis (AL-CA) and sinus node dysfunction (SND). This innovative pacing method improves heart failure outcomes by enhancing cardiac efficiency.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Amyloidosis Research
Background:
- Light-chain cardiac amyloidosis (AL-CA) involves myocardial amyloid deposition.
- Sinus node dysfunction (SND) is a common complication.
- Limited evidence exists on Bachmann's bundle (BB) pacing in AL-CA patients with SND.
Background:
Light-chain cardiac amyloidosis (AL-CA) is a rare disease caused by amyloid fibril deposition in the myocardium. Evidence on Bachmann's bundle (BB) pacing in patients with AL-CA and sinus node dysfunction (SND) remains scarce.
Case Summary:
A 74-year-old woman with SND and worsening heart failure was admitted to our hospital. An endomyocardial biopsy during pacemaker implantation was helpful in the diagnosis of AL-CA. After the pacing study, it was found that high right atrial septal pacing near the BB region produced a higher P-wave amplitude and shorter duration than sinus rhythm and right atrial appendage pacing. The findings indicate that BB pacing not only preserves sinus rhythm, it also enhances overall cardiac efficiency.
Discussion:
Few reports of BB pacing for SND exist in the literature. This case demonstrates a safe and effective method of improving heart failure outcomes.
Take-Home Message:
BB pacing may be a safe and effective treatment for patients with AL-CA and SND.
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