Cor Vasa 2025, 67(1):43-47 | DOI: 10.33678/cor.2024.099

(Detection and treatment of arrhythmias in patients with transthyretin cardiac amyloidosis)

Ivona Šimková, Renáta Aiglová, Enikö Marczibál, Marián Fedorco, Miloš Táborský
I. interní klinika - kardiologická, Lékařská fakulta Univerzity Palackého v Olomouci a Fakultní nemocnice Olomouc, Olomouc, Česká republika

Arrhythmias are a very common manifestation of transthyretin cardiac amyloidosis. The review article focuses on the mechanisms that lead to the development of atrial fibrillation, cardiac conduction disorders, and ventricular arrhythmias, as well as their incidence and prevalence. It emphasizes the possibilities of using external and implantable monitoring devices in the detection of arrhythmias. It summarizes modern therapeutic approaches with particular attention to radiofrequency catheter ablation and the use of direct oral anticoagulants in atrial fibrillation and flutter. It mentions the challenges of cardiac pacing and prevention of sudden cardiac death.

Keywords: Amyloidosis, Atrial fibrillation, Cardiac conduction disorders, Transthyretin cardiomyopathy, Ventricular arrhythmias,

Received: October 27, 2024; Revised: October 27, 2024; Accepted: November 29, 2024; Prepublished online: June 2, 2012; Published: March 1, 2025  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Šimková I, Aiglová R, Marczibál E, Fedorco M, Táborský M. (Detection and treatment of arrhythmias in patients with transthyretin cardiac amyloidosis). Cor Vasa. 2025;67(1):43-47. doi: 10.33678/cor.2024.099.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Ruberg FL, Maurer MS. Cardiac Amyloidosis Due to Transthyretin Protein: A Review. JAMA 2024;331:778-791. Go to original source... Go to PubMed...
    2. Aiglová R, Táborský M, Flodrová P, Schee A. Srdečnî transthyretinová amyloidóza. Cor Vasa 2020;62:267-271. Go to original source...
    3. Mints YY, Doros G, Berk JL, et al. Features of atrial fibrillation in wild-type transthyretin cardiac amyloidosis: a systematic review and clinical experience. ESC Heart Fail 2018;5:772-779. Go to original source... Go to PubMed...
    4. Donnellan E, Wazni OM, Hanna M, et al. Atrial Fibrillation in Transthyretin Cardiac Amyloidosis: Predictors, Prevalence, and Efficacy of Rhythm Control Strategies. JACC Clin Electrophysiol 2020;6:1118-1127. Go to original source... Go to PubMed...
    5. Longhi S, Quarta CC, Milandri A, et al. Atrial fibrillation in amyloidotic cardiomyopathy: prevalence, incidence, risk factors and prognostic role. Amyloid 2015;22:147-155. Go to original source... Go to PubMed...
    6. Giancaterino S, Urey MA, Darden D, Hsu JC. Management of Arrhythmias in Cardiac Amyloidosis. JACC Clin Electrophysiol 2020;6:351-361. Go to original source... Go to PubMed...
    7. Röcken C, Peters B, Juenemann G, et al. Atrial amyloidosis: an arrhythmogenic substrate for persistent atrial fibrillation. Circulation 2002;106:2091-2097. Go to original source... Go to PubMed...
    8. Mints YY, Doros G, Berk JL, et al. Electrophysiological Manifestations of Cardiac Amyloidosis: JACC: CardioOncology State-of-the-Art Review. ESC Heart Fail 2018;5:772-779. Go to original source... Go to PubMed...
    9. El-Am EA, Dispenzieri A, Melduni RM, et al. Direct Current Cardioversion of Atrial Arrhythmias in Adults With Cardiac Amyloidosis. J Am Coll Cardiol 2019;73:589-597. Go to original source... Go to PubMed...
    10. Schneider SM, Kochar K, Ruge M. Cardiogenic Shock Due to Atrial Arrhythmia as the Initial Presentation of Transthyretin Cardiac Amyloidosis. JACC Case Rep 2022;4:1490-1495. Go to original source... Go to PubMed...
    11. Feng D, Edwards WD, Oh JK. Intracardiac Thrombosis and Embolism in Patients With Cardiac Amyloidosis. Circulation 2007;116:2420-2426. Go to original source... Go to PubMed...
    12. Bukhari S, Barakat AF, Eisele YS. Prevalence of Atrial Fibrillation and Thromboembolic Risk in Wild-Type Transthyretin Amyloid Cardiomyopathy. Circulation 2021;143:1335-1337. Go to original source... Go to PubMed...
    13. Donnellan E, Elshazly MB, Vakamudi S. No Association Between CHADS-VASc Score and Left Atrial Appendage Thrombus in Patients With Transthyretin Amyloidosis. JACC Clin Electrophysiol 2019;5:1473-1474. Go to original source... Go to PubMed...
    14. Feng D, Syed IS, Martinez M, et al. Intracardiac thrombosis and anticoagulation therapy in cardiac amyloidosis. Circulation 2009;119:2490-2497. Go to original source... Go to PubMed...
    15. Bruce SL, Cuomo M, Yarmohammadi H, et al. Monitoring for arrhythmia in transthyretin cardiac amyloidosis with noninvasive ambulatory patch devices. Heart Rhythm O2 2024;5:631-638. Go to original source... Go to PubMed...
    16. Dale Z, Chandrashekar P, Al-Rashdan L,et al. Routine ambulatory heart rhythm monitoring for detection of atrial arrhythmias in transthyretin cardiac amyloidosis. Int J Cardiol 2022;358:65-71. Go to original source... Go to PubMed...
    17. Abbasi MA, El-Am E, Deshmukh A, et al. Long-Term, Implantable Event Monitoring of Patients With Wild-Type Transthyretin Cardiac Amyloidosis: A Pilot Study. JACC CardioOncol 2024;6:313-314. Go to original source... Go to PubMed...
    18. Dale Z, Chandrashekar P, Al-Rashdan L, et al. Management Strategies for Atrial Fibrillation and Flutter in Patients with Transthyretin Cardiac Amyloidosis. Am J Cardiol 2021;157:107-114. Go to original source... Go to PubMed...
    19. Donnellan E, Wazni O, Kanj M, et al. Atrial fibrillation ablation in patients with transthyretin cardiac amyloidosis. Europace. 2020;22:259-264. Go to original source... Go to PubMed...
    20. Kanazawa H, Takashio S, Hoshiyama T, et al. Clinical outcomes of catheter ablation for atrial fibrillation, atrial flutter, and atrial tachycardia in wild-type transthyretin amyloid cardiomyopathy: a proposed treatment strategy for catheter ablation in each arrhythmia. Europace 2024;26:euae155. Go to original source... Go to PubMed...
    21. Alhassan HA, Kainat A, Donohue J, et al. Safety of Catheter Ablation Therapy for Atrial Fibrillation in Cardiac Amyloidosis. J Am Heart Assoc 2023;12:e029339. Go to original source... Go to PubMed...
    22. Van Gelder IC, Rienstra M, Bunting KV, et al. 2024 ESC Guidelines for the management of atrial fibrillation. ESC Clinical Practice Guidelines. Eur Heart J 2024;45:3314-3414. Go to original source... Go to PubMed...
    23. Vilches S, Fontana M, Gonzalez-Lopez E, et al. Systemic embolism in amyloid transthyretin cardiomyopathy. Eur J Heart Fail 2022;24:1387-1396. Go to original source... Go to PubMed...
    24. Lacy SC, Kinno M, Joyce C, Yu MD. Direct Oral Anticoagulants in Patients With Cardiac Amyloidosis: A Systematic Review and Meta-Analysis. Int J Heart Fail 2023;6:36-43. Go to original source... Go to PubMed...
    25. Bourgault S, Choi S, Buxbaum JN, et al. Mechanisms of transthyretin cardiomyocyte toxicity inhibition by resveratrol analogs. Biochem Biophys Res Commun 2011;410:707-713. Go to original source... Go to PubMed...
    26. Jonker DL, Hazenberg BPC, Nienhuis HLA, et al. Imaging cardiac innervation in hereditary transthyretin (ATTRm) amyloidosis: A marker for neuropathy or cardiomyopathy in case of heart failure? J Nucl Cardiol 2020;27:1774-1784. Go to original source... Go to PubMed...
    27. Sousa MM, Cardoso I, Fernandes R, et al. Deposition of Transthyretin in Early Stages of Familial Amyloidotic Polyneuropathy. Am J Pathol 2001;159:1993-2000. Go to original source... Go to PubMed...
    28. Donnellan E, Wazni OM, Saliba WI, et al. Prevalence, Incidence, and Impact on Mortality of Conduction System Disease in Transthyretin Cardiac Amyloidosis. Am J Cardiol 2020;128:140-146. Go to original source... Go to PubMed...
    29. Rapezzi C, Merlini G, Quarta CC, et al. Systemic Cardiac Amyloidoses: Disease Profiles and Clinical Courses of the 3 Main Types. Circulation 2009;120:1203-1212. Go to original source... Go to PubMed...
    30. Rehorn MR, Loungani RS, Black-Maier E, et al. Cardiac Implantable Electronic Devices: A Window Into the Evolution of Conduction Disease in Cardiac Amyloidosis. JACC Clin Electrophysiol 2020;6:1144-1154. Go to original source... Go to PubMed...
    31. Donnellan E, Wazni OM, Saliba WI, et al. Cardiac devices in patients with transthyretin amyloidosis: Impact on functional class, left ventricular function, mitral regurgitation, and mortality. J Cardiovasc Electrophysiol 2019;30:2427-2432. Go to original source... Go to PubMed...
    32. Hartnett J, Jaber W, Maurer M, et al. Electrophysiological Manifestations of Cardiac Amyloidosis: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2021;3:506-515. Go to original source... Go to PubMed...
    33. Hörnsten R, Wiklund U, Olofsson BO, et al. Liver transplantation does not prevent the development of life-threatening arrhythmia in familial amyloidotic polyneuropathy, Portuguese-type (ATTR Val30Met) patients. Transplantation 2004;78:112-116. Go to original source... Go to PubMed...
    34. Knoll K, Fuchs P, Weidmann I, et al. Incidence and Predictors of Ventricular Arrhythmias in Transthyretin Amyloid Cardiomyopathy. J Clin Med 2023;12:4624. Go to original source... Go to PubMed...
    35. Brown MT, Yalamanchili S, Evans ST, et al. Ventricular arrhythmia burden and implantable cardioverter-defibrillator outcomes in transthyretin cardiac amyloidosis. Pacing Clin Electrophysiol 2022;45:443-451. Go to original source... Go to PubMed...
    36. Donnellan E, Wazni OM, Hanna M, et al. Primary prevention implantable cardioverter-defibrillators in transthyretin cardiac amyloidosis. Pacing Clin Electrophysiol 2020;43:1401-1403. Go to original source... Go to PubMed...
    37. Dale Z, Al-Rashdan L, Elman M, et al. Mode of death and outcomes of implantable cardioverter defibrillators in transthyretin amyloid cardiomyopathy. Int J Cardiol 2022;349:99-102. Go to original source... Go to PubMed...
    38. Kim EJ, Holmes BB, Huang S, et al. Outcomes in patients with cardiac amyloidosis and implantable cardioverter-defibrillator. Europace 2020;22:1216-1223. Go to original source... Go to PubMed...
    39. Varr BC, Zarafshar S, Coakley T, et al. Implantable cardioverter--defibrillator placement in patients with cardiac amyloidosis. Heart Rhythm 2014;11:158-162. Go to original source... Go to PubMed...
    40. Hamon D, Algalarrondo V, Gandjbakhch E, et al. Outcome and incidence of appropriate implantable cardioverter-debrillator therapy in patients with cardiac amyloidosis. Int J Cardiol 2016;222:562-568. Go to original source... Go to PubMed...
    41. Maurer MS, Schwartz JH, Gundapaneni B, et al. Tafamidis Treatment for Patients with Transthyretin Amyloid Cardiomyopathy. N Engl J Med 2018;379:1007-1016. Go to original source... Go to PubMed...
    42. Elliott P, Drachman BM, Gottlieb SS, et al. Long-Term Survival With Tafamidis in Patients With Transthyretin Amyloid Cardiomyopathy. Circ Heart Fail 2022;15:e008193. Go to original source... Go to PubMed...
    43. Miyamoto M, Nakamura K, Nakagawa K, et al. Prevalence and Treatment of Arrhythmias in Patients With Transthyretin and Light-Chain Cardiac Amyloidosis. Circ Rep 2023;5:298-305. Go to original source... Go to PubMed...
    44. Girvin ZP, Sweat AO, Kochav SM, et al. Tafamidis and Incidence of Atrial Fibrillation in Transthyretin Amyloid Cardiomyopathy. JACC Clin Electrophysiol 2023;9:586-587. Go to original source... Go to PubMed...

    This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0), which permits non-comercial use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.


    Return to the content


    Cor et Vasa

    You are accessing a site intended for medical professionals, not the lay public. The site may also contain information that is intended only for persons authorized to prescribe and dispense medicinal products for human use.

    I therefore confirm that I am a healthcare professional under Act 40/1995 Coll. as amended by later regulations and that I have read the definition of a healthcare professional.


    No
    Yes