Abstract 16235: Rhythmic Disturbances in Patients With Cardiac Amyloidosis: Analysis From Cedars-Sinai Amyloidosis Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jae Hyung Cho ◽  
Natasha Cuk ◽  
Derek Leong ◽  
Ashkan Ehdaie ◽  
Eugenio Cingolani ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Secondary Prevention ◽  
Cardiac Arrhythmias ◽  
Cardiac Amyloidosis ◽  
Electronic Devices ◽  
Pacemaker Implantation ◽  
Ambulatory Monitoring ◽  
Al Amyloidosis ◽  
Cardioverter Defibrillator ◽  
Large Patient

Introduction: Cardiac arrhythmias are frequent complications of patients with cardiac amyloidosis. The burden and nature of cardiac arrhythmias in patients with cardiac amyloidosis have not been investigated in a large patient population. Hypothesis: Cardiac amyloidosis is a highly arrhythmogenic disorder requiring implantation of cardiac electronic devices. Methods: Cedars-Sinai amyloidosis registry was analyzed to investigate the prevalence and nature of cardiac arrhythmias in patients with cardiac amyloidosis. Ambulatory ECG monitoring data, implantable cardioverter-defibrillator or pacemaker implantation, and interrogation data were reviewed to study the burden of cardiac arrhythmias in patients with cardiac amyloidosis. Results: A total of 156 patients were analyzed in the registry: 51 patients (32.7%) with AL amyloidosis, 101 patients (64.7%) with ATTR amyloidosis, and 4 patients with AA amyloidosis (2.6%). Thirty-seven patients (23.7%) were implanted with cardioverter-defibrillator; 23 patients (14.7%) for primary prevention, 11 patients (7.1%) for secondary prevention of ventricular tachycardia, and 3 patients (1.9%) for secondary prevention of ventricular fibrillation. Twenty-two patients (12.1%) needed pacemaker implantation; 9 patients (5.8%) for high-grade or complete heart block, and 13 patients (8.3%) due to sick sinus syndrome. The most common arrhythmias were atrial fibrillation occurring in 80 patients (51.3%) followed by first-degree AV block in 31 patients (19.9%). Sustained ventricular tachycardia occurred in 14 patients (8.9%) during hospitalization, device interrogation or ambulatory monitoring. Conclusions: Both atrial and ventricular arrhythmias are common manifestations of cardiac amyloidosis, frequently necessitating implantation of cardiac electronic devices.

scholarly journals Outcomes in patients with cardiac amyloidosis and implantable cardioverter-defibrillator

EP Europace ◽  
2020 ◽  
Vol 22 (8) ◽  
pp. 1216-1223
Author(s):  
Eun-Jeong Kim ◽  
Benjamin B Holmes ◽  
Shi Huang ◽  
Ricardo Lugo ◽  
Asad Al Aboud ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Implantable Cardioverter Defibrillator ◽  
Cardiac Amyloidosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Al Amyloidosis ◽  
Transthyretin Amyloidosis ◽  
Ventricular Ejection Fraction ◽  
Cardioverter Defibrillator ◽  
Significant Difference

Abstract Aims Cardiac amyloidosis (CA) is associated with increased mortality due to arrhythmias, heart failure, and electromechanical dissociation. However, the role of an implantable cardioverter-defibrillator (ICD) remains unclear. We conducted case-control study to assess survival in CA patients with and without a primary prevention ICD and compared outcomes to an age, sex, and device implant year-matched non-CA group with primary prevention ICD. Methods and results There were 91 subjects with CA [mean age= 71.2 ± 10.2, female 22.0%, 49 AL with Mayo Stage 2.9 ± 1.0, 41 transthyretin amyloidosis (ATTR), 1 other] followed by Vanderbilt Amyloidosis centre. Patients with ICD (n = 23) were compared with those without (n = 68) and a non-amyloid group with ICD (n = 46). All subjects with ICD had implantation for primary prevention. Mean left ventricular ejection fraction was 36.2% ± 14.4% in CA with ICD, 41.0% ± 10.6% in CA without ICD, and 33.5% ± 14.4% in non-CA patients. Over 3.5 ± 3.1 years, 6 (26.1%) CA, and 12 (26.1%) non-CA subjects received ICD therapies (P = 0.71). Patients with CA had a significantly higher mortality (43.9% vs. 17.4%, P = 0.002) compared with the non-CA group. Mean time from device implantation to death was 21.8 months in AL and 22.8 months in ATTR patients. There was no significant difference in mortality between CA patients who did and did not receive an ICD (39.0% vs. 46.0%, P = 0.59). Conclusions Despite comparable event rates patients with CA had a significantly higher mortality and ICDs were not associated with longer survival. With the emergence of effective therapy for AL amyloidosis, further study of ICD is needed in this group.

scholarly journals Survival Following Implantable Cardioverter‐Defibrillator Implantation in Patients With Amyloid Cardiomyopathy

2020 ◽  
Vol 9 (18) ◽  
Author(s):  
Angela Y. Higgins ◽  
Amarnath R. Annapureddy ◽  
Yongfei Wang ◽  
Karl E. Minges ◽  
Rachel Lampert ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Ventricular Tachycardia ◽  
Cerebrovascular Disease ◽  
Implantable Cardioverter Defibrillator ◽  
Cardiac Amyloidosis ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Icd Implantation ◽  
Cardioverter Defibrillator ◽  
Factors Associated

Background Outcomes data in patients with cardiac amyloidosis after implantable cardioverter‐defibrillator (ICD) implantation are limited. We compared outcomes of patients with ICDs implanted for cardiac amyloidosis versus nonischemic cardiomyopathies (NICMs) and evaluated factors associated with mortality among patients with cardiac amyloidosis. Methods and Results Using National Cardiovascular Data Registry’s ICD Registry data between April 1, 2010 and December 31, 2015, we created a 1:5 propensity‐matched cohort of patients implanted with ICDs with cardiac amyloidosis and NICM. We compared mortality between those with cardiac amyloidosis and matched patients with NICM using Kaplan‐Meier survival curves and Cox proportional hazards models. We also evaluated risk factors associated with 1‐year mortality in patients with cardiac amyloidosis using multivariable Cox proportional hazards regression models. Among 472 patients with cardiac amyloidosis and 2360 patients with propensity‐matched NICMs, 1‐year mortality was significantly higher in patients with cardiac amyloidosis compared with patients with NICMs (26.9% versus 11.3%, P <0.001). After adjustment for covariates, cardiac amyloidosis was associated with a significantly higher risk of all‐cause mortality (hazard ratio [HR], 1.80; 95% CI, 1.56–2.08). In a multivariable analysis of patients with cardiac amyloidosis, several factors were significantly associated with mortality: syncope (HR, 1.78; 95% CI, 1.22–2.59), ventricular tachycardia (HR, 1.65; 95% CI, 1.15–2.38), cerebrovascular disease (HR, 2.03; 95% CI, 1.28–3.23), diabetes mellitus (HR, 1.55; 95% CI, 1.05–2.27), creatinine = 1.6 to 2.5 g/dL (HR, 1.99; 95% CI, 1.32–3.02), and creatinine >2.5 (HR, 4.34; 95% CI, 2.72–6.93). Conclusions Mortality after ICD implantation is significantly higher in patients with cardiac amyloidosis than in patients with propensity‐matched NICMs. Factors associated with death among patients with cardiac amyloidosis include prior syncope, ventricular tachycardia, cerebrovascular disease, diabetes mellitus, and impaired renal function.

Secondary prevention of sudden death in idiopathic dilated cardiomyopathy

ESC CardioMed ◽  
2018 ◽  
pp. 2346-2348
Author(s):  
Riccardo Cappato
Keyword(s):  
Ventricular Tachycardia ◽  
High Risk ◽  
Ventricular Fibrillation ◽  
Sudden Death ◽  
Ventricular Arrhythmia ◽  
Secondary Prevention ◽  
Myocardial Ischaemia ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Cardioverter Defibrillator ◽  
Reversible Nature

Ventricular fibrillation or symptomatic sustained ventricular tachycardia may occur regardless of the presence and type of cardiac substrate. Survivors of these arrhythmias have a high risk of recurrence arrhythmias, which may often be fatal. With the exception of precipitating conditions of a reversible nature (e.g. myocardial ischaemia, acute electrolyte unbalance, myocarditis, and drug intoxication), there is wide consensus that survivors of a near-fatal ventricular arrhythmia require chronic protection with an implantable cardioverter defibrillator (ICD).

917Appropriate shocks in WCD patients - Results from the Austrian WCD registry

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
U Rohrer ◽  
M Manninger ◽  
T Odeneg ◽  
D Zweiker ◽  
D Moertl ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Ventricular Fibrillation ◽  
Risk Stratification ◽  
Secondary Prevention ◽  
Shock Rate ◽  
Icd Implantation ◽  
Cardioverter Defibrillator ◽  
Temporary Treatment ◽  
Risk Stratification Tool ◽  
Appropriate Shocks

Abstract Background The wearable cardioverter-defibrillator (WCD) is a temporary treatment option for patients at high risk for sudden cardiac death (SCD) and/or for patients in whom implantation of a cardioverter defibrillator (ICD) is temporarily not possible. Purpose To investigate incidence and predictors of appropriate WCD shocks. Methods We performed a retrospective analysis of all patients with appropriate shocks delivered by a WCD in the cohort of the Austrian WCD registry between 2010 and 2018. Within this dataset, we identified predictors within the baseline characteristics, the indication for the WCD and preceding alarms automatically recorded by the WCD. Results: Baseline Within 879 registered in the Austrian WCD registry, 31 patients (3,5%) received appropriate WCD shocks due to ventricular tachycardia (VT) or ventricular fibrillation (VF). Compared to the total cohort, shocked patients were elder (mean age 67 ± 14 vs. 60 ± 14 years, p = 0,001) and the percentage of female patients was lower (11% vs. 21%, p = 0,262). The mean baseline LVEF at prescription was 33 ± 15% in the population with appropriate shocks compared to 32 ± 14% in the all-over cohort (p = ns). In the Austrian WCD population, 378/879 patients had a WCD due to secondary prevention. Within this cohort 5,6% (21/378) had shocks for VT/VF again, compared to 10/501 (2%) shocked patients in the primary prevention cohort. 31/879 (3.5%) patients received 57 appropriate shocks, the per patient shock rate was 2 [1;5]. These shocks were induced by 25 ventricular tachycardia and 26 times ventricular fibrillation. The octagenarians with 11% (7/34) shocked patients, showed a significant higher likelihood to receive shocks (p = 0,008) as well as the cohort of secondary preventive prescribed WCD-patients (p = 0,007). There were more shocks in patients, when prescribed with a WCD due to ICD associated infections (p = 0,001), when used as a bridge to ICD (p = 0,042) and in patients with ongoing risk stratification (p = 0,009). Looking through the automatically recorded alarms preceding a WCD shock, shocked patients experienced significantly more often non sustained VTs (p &lt; 0,0005) and sustained VTs that were haemodynamically tolerated and did not require a treatment (p &lt; 0,0005). Conclusion The WCD is effective in preventing SCD and an important risk stratification tool. We identified advanced age, patients with either already confirmed indication for ICD implantation (either temporary contraindication for implantation or temporary explantation) or risk stratification of an unclear cardiomyopathy, the cohort of secondary prevention and preceding nsVTs and stable VTs as predictors for appropriate WCD therapies.

Appropriate and inappropriate implantable cardioverter defibrillator interventions during secondary prevention

2008 ◽  
Vol 63 (1) ◽  
pp. 39-45 ◽  
Author(s):  
L.B.J. Van Der Velden ◽  
W. Huybrechts ◽  
B. Adriaensens ◽  
J. Ector ◽  
H. Ector ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Implantable Cardioverter Defibrillator ◽  
Cardioverter Defibrillator

scholarly journals POSTERS (2)96CONTINUOUS VERSUS INTERMITTENT MONITORING FOR DETECTION OF SUBCLINICAL ATRIAL FIBRILLATION IN HIGH-RISK PATIENTS97HIGH DAY-TO-DAY INTRA-INDIVIDUAL REPRODUCIBILITY OF THE HEART RATE RESPONSE TO EXERCISE IN THE UK BIOBANK DATA98USE OF NOVEL GLOBAL ULTRASOUND IMAGING AND CONTINUEOUS DIPOLE DENSITY MAPPING TO GUIDE ABLATION IN MACRO-REENTRANT TACHYCARDIAS99ANTICOAGULATION AND THE RISK OF COMPLICATIONS IN PATIENTS UNDERGOING VT AND PVC ABLATION100NON-SUSTAINED VENTRICULAR TACHYCARDIA FREQUENTLY PRECEDES CARDIAC ARREST IN PATIENTS WITH BRUGADA SYNDROME101USING HIGH PRECISION HAEMODYNAMIC MEASUREMENTS TO ASSESS DIFFERENCES IN AV OPTIMUM BETWEEN DIFFERENT LEFT VENTRICULAR LEAD POSITIONS IN BIVENTRICULAR PACING102CAN WE PREDICT MEDIUM TERM MORTALITY FROM TRANSVENOUS LEAD EXTRACTION PRE-OPERATIVELY?103PREVENTION OF UNECESSARY ADMISSIONS IN ATRIAL FIBRILLATION104EPICARDIAL CATHETER ABLATION FOR VENTRICULAR TACHYCARDIA ON UNINTERRUPTED WARFARIN: A SAFE APPROACH?105HOW WELL DOES THE NATIONAL INSTITUTE OF CLINICAL EXCELLENCE (NICE) GUIDENCE ON TRANSIENT LOSS OF CONSCIOUSNESS (T-LoC) WORK IN A REAL WORLD? AN AUDIT OF THE SECOND STAGE SPECIALIST CARDIOVASCULAT ASSESSMENT AND DIAGNOSIS106DETECTION OF ATRIAL FIBRILLATION IN COMMUNITY LOCATIONS USING NOVEL TECHNOLOGY'S AS A METHOD OF STROKE PREVENTION IN THE OVER 65'S ASYMPTOMATIC POPULATION - SHOULD IT BECOME STANDARD PRACTISE?107HIGH-DOSE ISOPRENALINE INFUSION AS A METHOD OF INDUCTION OF ATRIAL FIBRILLATION: A MULTI-CENTRE, PLACEBO CONTROLLED CLINICAL TRIAL IN PATIENTS WITH VARYING ARRHYTHMIC RISK108PACEMAKER COMPLICATIONS IN A DISTRICT GENERAL HOSPITAL109CARDIAC RESYNCHRONISATION THERAPY: A TRADE-OFF BETWEEN LEFT VENTRICULAR VOLTAGE OUTPUT AND EJECTION FRACTION?110RAPID DETERIORATION IN LEFT VENTRICULAR FUNCTION AND ACUTE HEART FAILURE AFTER DUAL CHAMBER PACEMAKER INSERTION WITH RESOLUTION FOLLOWING BIVENTRICULAR PACING111LOCALLY PERSONALISED ATRIAL ELECTROPHYSIOLOGY MODELS FROM PENTARAY CATHETER MEASUREMENTS112EVALUATION OF SUBCUTANEOUS ICD VERSUS TRANSVENOUS ICD- A PROPENSITY MATCHED COST-EFFICACY ANALYSIS OF COMPLICATIONS & OUTCOMES113LOCALISING DRIVERS USING ORGANISATIONAL INDEX IN CONTACT MAPPING OF HUMAN PERSISTENT ATRIAL FIBRILLATION114RISK FACTORS FOR SUDDEN CARDIAC DEATH IN PAEDIATRIC HYPERTROPHIC CARDIOMYOPATHY: A SYSTEMATIC REVIEW AND META-ANALYSIS115EFFECT OF CATHETER STABILITY AND CONTACT FORCE ON VISITAG DENSITY DURING PULMONARY VEIN ISOLATION116HEPATIC CAPSULE ENHANCEMENT IS COMMONLY SEEN DURING MR-GUIDED ABLATION OF ATRIAL FLUTTER: A MECHANISTIC INSIGHT INTO PROCEDURAL PAIN117DOES HIGHER CONTACT FORCE IMPAIR LESION FORMATION AT THE CAVOTRICUSPID ISTHMUS? INSIGHTS FROM MR-GUIDED ABLATION OF ATRIAL FLUTTER118CLINICAL CHARACTERISATION OF A MALIGNANT SCN5A MUTATION IN CHILDHOOD119RADIOFREQUENCY ASSOCIATED VENTRICULAR FIBRILLATION120CONTRACTILE RESERVE EXPRESSED AS SYSTOLIC VELOCITY DOES NOT PREDICT RESPONSE TO CRT121DAY-CASE DEVICES - A RETROSPECTIVE STUDY USING PATIENT CODING DATA122PATIENTS UNDERGOING SVT ABLATION HAVE A HIGH INCIDENCE OF SECONDARY ARRHYTHMIA ON FOLLOW UP: IMPLICATIONS FOR PRE-PROCEDURE COUNSELLING123PROGNOSTIC ROLE OF HAEMOGLOBINN AND RED BLOOD CELL DITRIBUTION WIDTH IN PATIENTS WITH HEART FAILURE UNDERGOING CARDIAC RESYNCHRONIZATION THERAPY124REMOTE MONITORING AND FOLLOW UP DEVICES125A 20-YEAR, SINGLE-CENTRE EXPERIENCE OF IMPLANTABLE CARDIOVERTER DEFIBRILLATORS (ICD) IN CHILDREN: TIME TO CONSIDER THE SUBCUTANEOUS ICD?126EXPERIENCE OF MAGNETIC REASONANCE IMAGING (MEI) IN PATIENTS WITH MRI CONDITIONAL DEVICES127THE SINUS BRADYCARDIA SEEN IN ATHLETES IS NOT CAUSED BY ENHANCED VAGAL TONE BUT INSTEAD REFLECTS INTRINSIC CHANGES IN THE SINUS NODE REVEALED BY I (F) BLOCKADE128SUCCESSFUL DAY-CASE PACEMAKER IMPLANTATION - AN EIGHT YEAR SINGLE-CENTRE EXPERIENCE129LEFT VENTRICULAR INDEX MASS ASSOCIATED WITH ESC HYPERTROPHIC CARDIOMYOPATHY RISK SCORE IN PATIENTS WITH ICDs: A TERTIARY CENTRE HCM REGISTRY130A DGH EXPERIENCE OF DAY-CASE CARDIAC PACEMAKER IMPLANTATION131IS PRE-PROCEDURAL FASTING A NECESSITY FOR SAFE PACEMAKER IMPLANTATION?

EP Europace ◽  
2016 ◽  
Vol 18 (suppl 2) ◽  
pp. ii36-ii47
Author(s):  
T. Philippsen ◽  
M. Orini ◽  
C.A. Martin ◽  
E. Volkova ◽  
J.O.M. Ormerod ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ventricular Tachycardia ◽  
Hypertrophic Cardiomyopathy ◽  
Pacemaker Implantation ◽  
Left Ventricular ◽  
Day Case ◽  
Single Centre ◽  
Subcutaneous Icd

scholarly journals Factors That Cause Concerns after Cardioverter Defibrillator Implantation

2021 ◽  
Vol 18 (11) ◽  
pp. 6095
Author(s):  
Olimpia Karczewska ◽  
Agnieszka Młynarska
Keyword(s):  
Observational Study ◽  
Secondary Prevention ◽  
Negative Emotions ◽  
Female Gender ◽  
Multiple Regression Model ◽  
Icd Implantation ◽  
Cardioverter Defibrillator ◽  
Input Method ◽  
Two Stages

Background and Objectives: The aim of the study was to assess the factors that influence the occurrence of concerns and their intensification after the implantation of a cardioverter defibrillator. Materials and Methods: This was a prospective and observational study including 158 patients. The study was conducted in two stages: stage I before implantable cardioverter defibrillator (ICD) implantation and stage II follow-up visit six months after ICD implantation. Standardized questionnaires were used in both stages. Results: Age and female gender were significantly correlated with the occurrence and intensity of concerns. Patients who had a device implanted for secondary prevention also experienced higher levels of concern. Additionally, a multiple regression model using the stepwise input method was performed. The model was statistically significant and explained 42% of the observed variance in the dependent variable (p = 0.0001, R2 = 0.4215). The analysis showed that age (p = 0.0036), insomnia (p = 0.0276), anxiety (p = 0.0000) and negative emotions (p = 0.0374) were important predictors of the dependent variable and enabled higher levels of the number of concerns to be predicted. Conclusions: There is a relationship between the severity of the concerns related to an implanted ICD and age, gender, anxiety, negative emotions and insomnia. Indications for ICD implantation may be associated with increased concerns about ICD.

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