Abstract 20433: Role of Cardiac Implantable Device Therapy in Patients With ATTR Wild Type Amyloidosis : A Retrospective Analysis of Mortality Outcomes
Introduction: The role of cardiac implantable electronic device(CIED) therapy in patients with ATTR (senile) amyloid is not very well defined.
Methods: We performed a retrospective analysis of a prospectively collected registry of patients with biopsy proven ATTR amyloid, followed up at Mayo Clinic, Rochester, Minnesota between Jan 1,1985 to Sep 30, 2015. The follow-up of these patients after diagnosis was done via personal communication, either written or verbal, and entered into the database. During analysis these patients were subdivided on the basis of the presence or absence of a CIED and all-cause mortality outcomes were analyzed using X2 test of significance and RR determined. In addition, CIEDs were subdivided into pacemakers, defibrillators(ICDs) and cardiac resynchronization devices(CRT-P/D) and the mortality among the patients with each device subtype was estimated and compared to overall mortality. Absolute risk reduction(ARR) and relative risk reduction(RRR) ratios were calculated for each group compared to mortality in ATTR patients without a CIED.
Results: The results are summarized in Table 1. ICDs were associated with the greatest difference in mortality with an ARR of 8.4% and RRR of 13.4%, which did not reach statistical significance. Figure 1 shows the Kaplan-Meir survival plots (Wilcoxon p=0.19). Univariate Cox proportional hazards modelling for ICD vs. no ICD had a HR of -0.21 (95% CI 0.59-0.13, p =0.24)
Conclusions: There is no mortality benefit in the implantation of CIEDs in patients with amyloidosis. Cost benefit estimates need to be made to evaluate the efficacy of device therapy in this group of patients.
Author Disclosures: D. Padmanabhan: None. A. Chahal: None. J. Knight: None. N. Tandon: None. P. Chacko: None. V.K. Somers: None. A. Dispenzieri: None. M. Grogan: None. P. Brady: None. G. Lin: None.
- © 2016 by American Heart Association, Inc.