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. 2025 Mar;4(3):101604.
doi: 10.1016/j.jacadv.2025.101604. Epub 2025 Feb 15.

Management of Rhythm and Conduction Disorders in Cardiac Amyloidosis: A French Nationwide Delphi Study

Charles Guenancia  1 , Benoit Lequeux  2 , Walid Amara  3 , Otilia Buiciuc  4 , Thibaud Damy  5 , Pascal Defaye  6 , Alexandre Duparc  7 , Jean-Christophe Eicher  8 , Rodrigue Garcia  9 , Vincent Galand  10 , Olivier Lairez  11 , Nicolas Lellouche  12 , Silvia Oghina  5
Affiliations

Management of Rhythm and Conduction Disorders in Cardiac Amyloidosis: A French Nationwide Delphi Study

Charles Guenancia et al. JACC Adv. 2025 Mar.

Abstract

Background: Cardiac amyloidosis (CA) is an increasingly recognized cardiomyopathy with an associated risk of arrhythmias and conduction disorders; however, managing arrhythmias and conductive disorders remains largely undefined.

Objectives: This study aims to gather French expert experience on current practices and treatment strategies for managing arrhythmias and conduction disorders in CA. The main areas of interest included atrial fibrillation (AF) management, anticoagulation therapy, and criteria for implanting cardiac rhythm devices.

Methods: A modified Delphi method was employed, involving a panel of 56 cardiologists and electrophysiologists specializing in CA. The panel evaluated 248 statements over 2 rounds. Consensus was defined as agreement from at least 66.7% of the panel, with strong consensus requiring more than 50% complete agreement.

Results: Consensus was achieved on 177 out of 248 statements across 2 rounds (71%). Key agreements included 1) the necessity for regular Holter monitoring and anticoagulation therapy in high-risk scenarios; 2) a rhythm control management strategy, including the use of amiodarone and AF ablation, particularly in the early stages of the disease; and 3) the use of cardiac devices for advanced conduction disorders, with decisions influenced by disease staging and left ventricular ejection fraction.

Conclusions: Approximately 70% of the proposed statements achieved agreement among the experts, reflecting reasonable alignment on anticoagulation therapy, AF management, and implantable cardiac devices. However, the study also highlights the need for personalized, multidisciplinary management of arrhythmias and conduction disorders in CA and emphasizes the need for future research to develop evidence-based guidelines.

Keywords: Delphi method; atrial fibrillation; cardiac amyloidosis; implantable cardioverter defibrillator; pacemaker; ventricular arrhythmias.

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Conflict of interest statement

Funding support and author disclosures This Delphi study was sponsored by Pfizer, France. Prof Guenancia has received personal fees from MicroPort CRM, Medtronic, AstraZeneca, Bristol Myers Squibb (BMS), Pfizer, Abbott, and AOP Pharma. Dr Lequeux reports financial ties with Pfizer. Dr Amara has received consulting and speaker fees from Pfizer, Biotronik, Medtronic, Boston Scientific, Microport, and Abbott. Dr Buiciuc is associated with Pfizer in relation to this study. Prof Damy reports relationships with Alnylam, Alexion, AstraZeneca, Bayer, Pfizer, BridgeBio, Neurimmune, Prothena, and Novo Nordisk. Dr Eicher has received consulting fees and honoraria from Pfizer and Alnylam. Prof Lairez has served as a consultant and speaker for Alnylam, Amicus, and Pfizer, a consultant for AstraZeneca, and as a speaker for BMS and Siemens Healthineers. Prof Lellouche has received speaker fees from BMS and Pfizer, and consulting fees from Medtronic, Abbott, and Boston Scientific. Dr Oghina has received honoraria from Pfizer, Bayer, Alnylam, and AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Delphi Study Process, Consensus Results, and Respondent Distribution Across France (A) The study was overseen by a 13-member scientific committee, including 3 nonvoting coordinators and 10 experts. A total of 56 panelists evaluated 248 statements. Consensus was reached on 140 statements in round 1, with an additional 37 statements achieving consensus in round 2. (B) A map illustrates the geographical distribution of experts across France (Datawrapper).
Central Illustration
Central Illustration
Key Results and Research Gaps in Managing Rhythm and Conduction Disorders in Cardiac Amyloidosis, as Determined by a French Nationwide Delphi Panel AL = amyloid light-chain; ATTR = transthyretin amyloidosis; CRT = cardiac resynchronization therapy.
See this image and copyright information in PMC

References

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