Implantable cardioverter defibrillators in patients with cardiac amyloidosis

Grace D Lin, Angela Dispenzieri, Robert Kyle, Martha Grogan, Peter A. Brady

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

ICD in Cardiac Amyloidosis Background Cardiac amyloidosis (CA) is associated with increased risk of sudden cardiac arrest. Although ICD therapy improves survival in patients with cardiomyopathy due to other etiologies, the benefit of ICD therapy in patients with CA is unclear in large part due to limited data on the precise mechanism of sudden cardiac arrest and selection of patients with cardiac amyloidosis for ICD therapy. Objective The objective was to determine the benefit of ICD therapy in cardiac amyloidosis. Methods We reviewed all ICD implant indications, procedures, and therapies, of CA patients evaluated at Mayo Clinic between 2000 and 2009. Results A total of 53 patients with CA (33 AL, 10 senile, 9 familial, and 1 AA) who underwent ICD implantation were included. Indication for ICD implantation was for primary prevention of sudden cardiac arrest in 41 (77%) patients and secondary prevention in 12 (23%) patients. The rate of appropriate ICD shocks was 32% in the first year and was observed almost exclusively in AL amyloidosis patients, occurring in 15 patients (12 AL amyloidosis, 2 senile, 1 AA). Appropriate ICD shocks were more frequent in patients with prior sudden cardiac arrest or sustained ventricular arrhythmias (secondary prevention indication), and less frequent in patients who presented with decreased ejection fraction or syncope. Conclusions A high rate of appropriate ICD shocks was observed especially in patients with AL-type amyloidosis. However, appropriate ICD therapy did not translate into overall survival benefit, suggesting that selection of patients with CA who might be candidates for ICD is imprecise.

Original languageEnglish (US)
Pages (from-to)793-798
Number of pages6
JournalJournal of Cardiovascular Electrophysiology
Volume24
Issue number7
DOIs
StatePublished - Jul 2013

Fingerprint

Implantable Defibrillators
Amyloidosis
Sudden Cardiac Death
Shock
Secondary Prevention
Patient Selection
Therapeutics
Survival
Syncope
Primary Prevention
Cardiomyopathies
Cardiac Arrhythmias

Keywords

  • cardiac amyloidosis
  • heart failure
  • implantable cardioverter defibrillator
  • sudden death
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Implantable cardioverter defibrillators in patients with cardiac amyloidosis. / Lin, Grace D; Dispenzieri, Angela; Kyle, Robert; Grogan, Martha; Brady, Peter A.

In: Journal of Cardiovascular Electrophysiology, Vol. 24, No. 7, 07.2013, p. 793-798.

Research output: Contribution to journalArticle

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