Prevalence, Incidence, and Impact on Mortality of Conduction System Disease in Transthyretin Cardiac Amyloidosis

被引:55
作者
Donnellan, Eoin [1 ]
Wazni, Oussama M. [1 ]
Saliba, Walid, I [1 ]
Hanna, Mazen [1 ]
Kanj, Mohamed [1 ]
Patel, Divyang R. [1 ]
Wilner, Bryan [1 ]
Kochar, Arshneel [1 ]
Jaber, Wael A. [1 ]
机构
[1] Cleveland Clin, Dept Cardiovasc Med, Cleveland, OH 44106 USA
关键词
BUNDLE-BRANCH BLOCK; ASSOCIATION; RECOMMENDATIONS; CARDIOMYOPATHY; OUTCOMES; SOCIETY; RISK;
D O I
10.1016/j.amjcard.2020.05.021
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Transthyretin cardiac amyloidosis (ATTR-CA) is an increasingly recognized infiltrative cardiomyopathy in which conduction system disease is common. The aim of our study was to define the incidence and prevalence of high-grade atrioventricular (AV) block requiring pacemaker implantation in our quaternary referral center. This was a single-center retrospective cohort study of 369 consecutive patients with ATTR-CA who underwent 12-lead electrocardiogram at the time of ATTR-CA diagnosis. During a mean follow-up of 28 months, serial ECGs and the electronic medical record were examined for the development of high-grade AV block and pacemaker implantation. Wild-type ATTR-CA (wtATTR-CA) was diagnosed in 261 patients and 108 had hereditary ATTR-CA (hATTR-CA). A total of 35 (9.5%) had high-grade AV block requiring pacemaker implantation at the time of diagnosis of ATTR-CA. The most common conduction abnormalities evident on the baseline ECG were a wide QRS complex, present in 51% with wtATTR-CA and 48% with hATTR-CA (p = 0.62), followed by first-degree AV block, which was present in 49% with wtATTR-CA and 43% with hATTR-CA (p = 0.31). During follow-up, highgrade AV block developed in 10% of those with hATTR-CA and 12% of patients with wtATTR-CA (p = 0.64). On multivariable models, high-grade AV block was not significantly associated with increased mortality. More advanced ATTR-CA stage and a history of obstructive coronary artery disease were associated with increased mortality on multivariable models. In conclusion, the incidence and prevalence of high-grade AV block is high in patients with ATTR-CA. Patients with ATTR-CA require close monitoring during follow-up for the development of conduction system disease. (C) 2020 Elsevier Inc. All rights reserved.
引用
收藏
页码:140 / 146
页数:7
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