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Inicio Medicina Clínica (English Edition) Electrocardiographic features and need for pacemaker in cardiac amyloidosis: Ana...
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Vol. 159. Issue 2.
Pages 78-84 (July 2022)
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Vol. 159. Issue 2.
Pages 78-84 (July 2022)
Original article
Electrocardiographic features and need for pacemaker in cardiac amyloidosis: Analysis of 58 cases
Alteraciones Electrocardiográficas y Necesidad de Marcapasos en Amiloidosis Cardiaca: Análisis de 58 Casos
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Cristina Pericet-Rodrigueza,b, José López-Aguileraa,b,
Corresponding author
mircardjla@gmail.com

Corresponding author.
, Carmen Durán-Torralbaa,b, Juan Carlos Castillo-Domingueza,b, Martín Ruiz-Ortiza,b, Jorge Perea-Armijoa,b, Mónica Delgado-Ortegaa,b, Dolores Mesa-Rubioa,b, Rafael González-Manzanaresa,b, Joaquín Ruiz de Castroviejoa,b, Ernesto Martín-Doradoa,b, Ignacio Gallo-Fernándeza,b, Josúe López-Baizána,b, Daniel Pastor-Wulfa,b, Ana Rodriguez-Almodovara,b, Manuel Pan Álvarez-Osorioa,b, Manuel Anguita-Sáncheza,b
a Servicio de Cardiología, Hospital Universitario Reina Sofia, Córdoba, Spain
b Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain
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Abstract
Aim

Amyloidosis is a disease in which amyloid fibrils can be deposited in different cardiac structures, and several electrocardiographic abnormalities can be produced by this phenomenon. The objective of this study was to describe the most common basal electrocardiographic alterations in patients diagnosed with cardiac amyloidosis (CA) and to determine if these abnormalities have an impact on the need of pacemaker.

Methods

This retrospective study included patients who had an established diagnosis of CA [light-chain cardiac amyloidosis (LA-CA) or transthyretin cardiac amyloidosis (TTR-CA)] between January 2013 and March 2021. The baseline heart rate, the percentage of patients with a pseudo-infarct pattern, low-voltage pattern or cardiac conduction disturbances, and the impact of these factors on the need of pacemaker were analysed.

Results

Fifty-eight patients with CA (20 with LA-CA and 38 with TTR-CA) were included, and the majority were male (69.0%). Twenty-one patients had atrial fibrillation (AF) at diagnosis. Thirty-five patients had a pseudo-infarct pattern, 35% had a low-voltage pattern, and 22% had criteria for ventricular hypertrophy. Two hirds had a conduction disorder: 18 patients with first degree atrioventricular block, 12 right bundle branch block, 3 left bundle branch block and 25 with a branch hemiblock. There were no differences between LA-CA and TTR-CA. Patients with TTR-CA had a greater need for pacemakers in the follow-up (39 ± 40 meses). Bundle branch block was a predictor of the need for a permanent pacemaker (HR 23.43, 4.09–134.09, IC 95%, p = 0.01).

Conclusions

Electrocardiographic abnormalities in patients diagnosed wich CA are heterogeneus. Most frecuent is the presence of conduction disorders, the pseudoinfarction pattern, followed by the low voltage pattern. Patients with any bundle branch block at the baseline electrocardiogram need more frecuent to require a pacemaker during follow-up, especially in TTR-CA.

Keywords:
Cardiac amyloidosis
Pseudo-infarct
Low voltage
Heart failure
Pacemaker
Prognosis
Resúmen
Objetivo

En la amiloidosis cardiaca (AC) el material amiloide puede depositarse en diferentes estructuras cardiacas pudiendo producir diferentes alteraciones electrocardiográficas. El objetivo fue describir qué alteraciones electrocardiográficas son más frecuentes en pacientes con AC, analizando su impacto en la necesidad de marcapasos.

Metodos

Estudio retrospectivo que incluye pacientes diagnosticados de AC por cadenas ligeras (AC-AL) y AC por transtirretina (AC-TTR), entre Enero-2013 y Marzo-2021. Se analizó el ritmo basal, el porcentaje con patrón de pseudoinfarto, bajo voltaje o alteraciones de la conducción; se analizó el impacto en la necesidad de marcapasos definitivo.

Resultados

Se incluyeron 58 pacientes con AC (20 AC-AL, 38 AC-TTR). Varones (69%), 21 (36%) tenían FA al diagnóstico. El 60% tenía patrón de pseudoinfarto, 35% bajo voltaje y un 22% tenían criterios de hipertrofia ventricular. Dos tercios tenían algún trastorno de conducción: Bloqueo Auriculoventricular de primer grado, 18 pacientes (31%); 12 bloqueo completo de rama derecha (BCRD), 3 bloqueo completo de rama izquierda (BCRI) y 25 con un hemibloqueo de rama. No hubo diferencias entre AC-AL y AC-TTR. Los pacientes con AC-TTR tuvieron mayor necesidad de marcapasos en el seguimiento (39 ± 40 meses). El bloqueo completo de rama (BCR) fue un predictor de necesidad de marcapasos permanente (HR 23.43, 4.09–134.09, IC 95%, p = 0.01).

Conclusiones

Las alteraciones electrocardiográficas en pacientes diagnosticados de AC son heterogéneas, siendo la más frecuente la presencia de trastornos de conducción, el patrón de pseudoinfarto, seguido del de bajo voltaje. Los pacientes con cualquier BCR en el electrocardiograma basal son más propensos a precisar marcapasos en el seguimiento, sobre todo en AC-TTR.

Palabras clave:
Amiloidosis Cardiaca
Electrocardiograma
Pseudoinfarto
Bajo voltaje
Marcapasos

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