Management of Arrhythmias and Conduction Disorders in Amyloid Cardiomyopathy

Abstract

Cardiac amyloidosis, a condition characterized by abnormal protein deposition in the heart, leads to restrictive cardiomyopathy and is notably associated with an increased risk of arrhythmias and conduction disorders. This article reviews the current understanding and management strategies for these cardiac complications, with a focus on recent advancements and clinical challenges. The prevalence and impact of atrial arrhythmias, particularly atrial fibrillation, are examined, along with considerations for stroke risk and anticoagulation therapy. The article also addresses the complexities of managing rate and rhythm control, outlining the utility and limitations of pharmacological agents and interventions such as catheter ablation. Furthermore, it reviews the challenges in the treatment of ventricular arrhythmias, including the contentious use of implantable cardioverter-defibrillators for primary and secondary prevention. Individualized approaches, considering the unique characteristics of cardiac amyloidosis, are paramount. Continuous research and clinical exploration are essential to refine treatment strategies and improve outcomes in this challenging patient population.

Keywords: AL; ATTR; amyloid cardiomyopathy; amyloidosis.

Figure 1

Clinical aspects of arrhythmias and conduction disorders, and echocardiographic findings in amyloid cardiomyopathy (descriptions of panels from the left—transthoracic echoacardiography, parasternal long-axis projection, morphological features of transthyretin amyloidosis of the heart; transthoracic echoacardiography, parasternal short-axis view, visible concentric thickening of the granular muscle of the left ventricle; resting electrocardiogram, ventricular tachycardia in a patient with amyloid cardiomyoapathy; Holter monitoring, visible pause; thromboembolic risk).