Arrhythmic Sudden Cardiac Death and the Role of Implantable Cardioverter-Defibrillator in Patients with Cardiac Amyloidosis-A Narrative Literature Review

Abstract

Cardiac amyloidosis (CA) is considered to be associated with an increased risk of sudden cardiac death (SCD) due to ventricular tachyarrhythmias and electromechanical dissociation. However, current arrhythmic risk stratification and the role of an implantable cardioverter-defibrillator (ICD) for primary prevention of SCD remains unclear. This article provides a narrative review of the literature on electrophysiological abnormalities in the context of ventricular arrhythmias in patients with CA and the role of ICD in terms of survival benefit in this group of patients.

Keywords: cardiac amyloidosis; implantable cardioverter-defibrillator; sudden cardiac death; ventricular arrhythmias.

Figure 1

Proposed algorithm for qualifying patients with cardiac AL amyloidosis for ICD implantation in primary prevention. LVEF—left ventricular ejection fraction, T-proBNP—N-terminal pro B-type natriuretic peptide; NYHA—New York Heart Association; NSVT—non sustained ventricular tachycardia, LV-GLS—left ventricular global longitudinal strain assessed by speckle tracking echocardiography, LGE—late gadolinium enhancement in cardiac magnetic resonance imaging.