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Atrioventricular sequential pacing in cardiac amyloidosis: an acute Doppler echocardiographic and catheterization
V Mathew1, H Chaliki, R A Nishimura
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Insights
Atrioventricular (AV) sequential pacing did not improve hemodynamics in patients with amyloid heart disease and heart failure. This cardiac amyloidosis treatment strategy showed increased filling pressures and no improvement in cardiac index.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Cardiac Electrophysiology
Background:
- Cardiac amyloidosis frequently causes heart failure refractory to standard treatments, leading to poor prognoses.
- Dual-chamber pacing is a potential therapy for cardiomyopathy patients with persistent heart failure despite optimal medical care.
- This study investigates the acute hemodynamic effects of atrioventricular (AV) pacing in cardiac amyloidosis patients with refractory heart failure.
Purpose of the Study:
- To evaluate the acute hemodynamic response to AV sequential pacing in patients diagnosed with cardiac amyloidosis and experiencing refractory heart failure.
- To determine the efficacy of AV pacing as a therapeutic intervention for this specific patient population.
Main Methods:
- Three patients with amyloidosis-related medically refractory heart failure were studied.
- Simultaneous cardiac catheterization and Doppler echocardiography were performed during acute AV sequential pacing at varied AV intervals.
Main Results:
- All patients exhibited elevated filling pressures during AV sequential pacing.
- No significant improvement in cardiac index was observed; some patients experienced a decline.
Conclusions:
- Acute AV sequential pacing does not provide hemodynamic benefits for patients with amyloid heart disease and medically refractory heart failure.
- This pacing strategy may not be an effective treatment for improving cardiac function in this patient group.
Background And Hypothesis:
Congestive heart failure due to cardiac amyloidosis is often refractory to conventional medical management and is associated with a high mortality rate. Recently, dual-chamber pacemaker implantation has been proposed as a therapeutic option in the management of patients with certain forms of cardiomyopathy with persistent heart failure symptoms, despite optimal medical therapy. The present study evaluates the acute hemodynamic response to atrioventricular (AV) pacing in patients with cardiac amyloidosis who presented with refractory heart failure symptoms.
Methods:
Three patients with medically refractory heart failure due to cardiac involvement of amyloidosis underwent a simultaneous cardiac catheterization/Doppler echocardiography study with acute AV sequential pacing at varying AV intervals.
Results:
During pacing at various AV intervals, all patients showed an increased in their filling pressures and either no change or decline in their cardiac index.
Conclusion:
The current study demonstrates an absence of acute hemodynamic with AV sequential pacing in patients with amyloid heart disease and medically refractory heart failure symptoms.