Abstract 1657: Prophylactic Implantation Of Cardioverter Defibrillators In Patients With Severe Cardiac Amyloidosis
Objectives: Benefit of prophylactic implantation of a cardioverter defibrillator (ICD) in patients with cardiac light-chain amyloidosis (CA) was assessed.
Background: CA carries a high risk for sudden cardiac death (SCD).
Methods: Implantation of ICD was performed in 19 patients with histologically proven CA because of a high risk for SCD. These 19 patients were compared to historical controls of CA without ICD. Survival was defined as absence of death or heart transplantation. Definition of high risk for SCD was based on heart failure (NYHA ≥II), a history of unexplained syncope, interventricular septal thickness ≥15mm (IVS), left ventricular ejection fraction ≤45% (LVEF), ventricular premature contractions Lown ≥IVa, serum level of troponin T ≥0.03 μg/l (TnT) and/or a N-terminal-proBNP level ≥3500 ng/l.
Results: Patients had NYHA class ≥II (n=17; 89%), syncopes (n=9; 47%), IVS ≥15mm (n=17; 89%), LVEF ≤45% (n=5; 26%), Lown ≥IVa (n=15; 79%), TnT >0.03 μg/l (n=9; 47%), and NT-proBNP ≥3500 ng/l (n=12; 63%). There were no severe perioperative complications. During a median follow-up of 380 days 2 patients with sustained ventricular tachyarrhythmias were successfully treated by the ICD. There were 9 deaths from electromechanical dissociation (n=5), heart transplantation (n=2) or non-cardiac causes (n=2). Survival of ICD patients did not differ from matched controls. Non-survivors had higher NT-proBNP plasma levels (7576±1571 ng/l) than survivors (4036±737 ng/l, p<0.05).
Conclusions: ICD implantation in high-risk patients with CA is feasible, but while selected patients may benefit from an ICD, routine prophylactic implantation is not recommended. More specific predictors of SCD need to be identified.