The Underscreening of Cardiac Amyloidosis in Patients With Pacemakers-A Single Centre Retrospective Audit

Cardiac amyloidosis is commonly associated with cardiac conduction disease. We sought to determine the prevalence of advanced conduction disease requiring a pacemaker in patients with known cardiac amyloidosis to evaluate current screening practices among patients receiving pacemakers.

A two-stage analysis was conducted. First, a retrospective chart review was conducted for all patients with known transthyretin cardiac amyloidosis who attended the Cardiac Amyloidosis clinic at the Victorian and Tasmanian Amyloidosis Service (Australia) from 2014 to 2024 to identify those with a pacemaker implantation. Second, all patients who received a pacemaker at the same centre, were reviewed for the presence of cardiac amyloidosis. Demographic and clinical information was collected to identify "red flags" suggestive of cardiac amyloidosis and the patients that underwent screening were identified.

Of those patients with known transthyretin cardiac amyloidosis, 82 (39.8%) patients required a pacemaker for conduction disease. Of the 470 patients who had a pacemaker inserted and did not have a pre-existing diagnosis of cardiac amyloidosis, 50 (10.6%) patients had at least 3 red flags for cardiac amyloidosis. However, only five patients (1.1%) were screened for cardiac amyloidosis and four (80% of those screened) were diagnosed with the condition.

A significant proportion of patients with transthyretin cardiac amyloidosis had pre-existing pacemakers. However, only a small proportion of patients who required a pacemaker underwent screening, despite the presence of multiple high-risk features.