Let Us Pump The Brakes On The Heart: Optimal AV-nodal Agent For Atrial Fibrillation In Heart Failure With Preserved Ejection Fraction
HFSA ePoster Library. Dharmavaram N. 09/10/21; 343529; 291
Naga Dharmavaram
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Abstract
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Background: Atrial fibrillation is common in patients with transthyretin cardiac amyloidosis (ATTR-CA) and is associated with a high rate of intracardiac thrombosis and embolism. Anticoagulation is recommended irrespective of the CHA2DS2-VASc score and some patients initial presentation is an embolic event. We hypothesized that a significant percentage of patients would have atrial fibrillation on long-term monitoring.
Methods: This is a retrospective study of patients with ATTR-CA, who underwent long-term monitoring for cardiac arrhythmias between June 2018 and April 2021. Baseline demographics, cardiac biomarkers, New York Heart Association (NYHA) functional class assessment and arrhythmia monitor results were obtained. Gillmore stage was calculated for each patient (1 point for each of NT-proBNP >3000 pg/ml and eGFR < 45 ml/min/m2) for a range of 0 to 2 points corresponding to stages 1 to 3.
Results: Thirty-one patients with ATTR-CA who underwent long-term cardiac monitoring were included (18 with ATTRwt and 13 with ATTRv). Mean age was 77±11 years, 84% male with average NYHA class 2.2±0.7, NT-proBNP of 2,312±1977 pg/ml, hs Troponin T of 50±29 ng/L and eGFR of 53±20 ml/min/m2. Their mean Gillmore stage was 1.6±0.6. Subjects wore the monitor for an average of 13.3±2.4 days (range 2 to 14 days). Seven patients (23%) had atrial fibrillation or flutter of whom 2 (6%) were newly diagnosed. Two patients (6%) had high degree atrioventricular blockade and 1 had prolonged sinus pauses, all of whom underwent placement of a permanent pacemaker (at 2-, 29- and 119-days following results, respectively). Twenty-five patients (81%) had documented non-sustained ventricular tachycardia with an average of 37.2 episodes (range of 1 to 713). No patients had an implantable cardioverter defibrillator placed.
Conclusions: In patients with ATTR-CA there is an equal prevalence of new atrial arrhythmias and significant conduction disease requiring permanent pacing. The burden of ventricular arrhythmias was significantly higher than atrial arrhythmias in this population. This is contrary to other cardiomyopathies in which atrial arrhythmias often precede ventricular arrhythmias.
Methods: This is a retrospective study of patients with ATTR-CA, who underwent long-term monitoring for cardiac arrhythmias between June 2018 and April 2021. Baseline demographics, cardiac biomarkers, New York Heart Association (NYHA) functional class assessment and arrhythmia monitor results were obtained. Gillmore stage was calculated for each patient (1 point for each of NT-proBNP >3000 pg/ml and eGFR < 45 ml/min/m2) for a range of 0 to 2 points corresponding to stages 1 to 3.
Results: Thirty-one patients with ATTR-CA who underwent long-term cardiac monitoring were included (18 with ATTRwt and 13 with ATTRv). Mean age was 77±11 years, 84% male with average NYHA class 2.2±0.7, NT-proBNP of 2,312±1977 pg/ml, hs Troponin T of 50±29 ng/L and eGFR of 53±20 ml/min/m2. Their mean Gillmore stage was 1.6±0.6. Subjects wore the monitor for an average of 13.3±2.4 days (range 2 to 14 days). Seven patients (23%) had atrial fibrillation or flutter of whom 2 (6%) were newly diagnosed. Two patients (6%) had high degree atrioventricular blockade and 1 had prolonged sinus pauses, all of whom underwent placement of a permanent pacemaker (at 2-, 29- and 119-days following results, respectively). Twenty-five patients (81%) had documented non-sustained ventricular tachycardia with an average of 37.2 episodes (range of 1 to 713). No patients had an implantable cardioverter defibrillator placed.
Conclusions: In patients with ATTR-CA there is an equal prevalence of new atrial arrhythmias and significant conduction disease requiring permanent pacing. The burden of ventricular arrhythmias was significantly higher than atrial arrhythmias in this population. This is contrary to other cardiomyopathies in which atrial arrhythmias often precede ventricular arrhythmias.
Background: Atrial fibrillation is common in patients with transthyretin cardiac amyloidosis (ATTR-CA) and is associated with a high rate of intracardiac thrombosis and embolism. Anticoagulation is recommended irrespective of the CHA2DS2-VASc score and some patients initial presentation is an embolic event. We hypothesized that a significant percentage of patients would have atrial fibrillation on long-term monitoring.
Methods: This is a retrospective study of patients with ATTR-CA, who underwent long-term monitoring for cardiac arrhythmias between June 2018 and April 2021. Baseline demographics, cardiac biomarkers, New York Heart Association (NYHA) functional class assessment and arrhythmia monitor results were obtained. Gillmore stage was calculated for each patient (1 point for each of NT-proBNP >3000 pg/ml and eGFR < 45 ml/min/m2) for a range of 0 to 2 points corresponding to stages 1 to 3.
Results: Thirty-one patients with ATTR-CA who underwent long-term cardiac monitoring were included (18 with ATTRwt and 13 with ATTRv). Mean age was 77±11 years, 84% male with average NYHA class 2.2±0.7, NT-proBNP of 2,312±1977 pg/ml, hs Troponin T of 50±29 ng/L and eGFR of 53±20 ml/min/m2. Their mean Gillmore stage was 1.6±0.6. Subjects wore the monitor for an average of 13.3±2.4 days (range 2 to 14 days). Seven patients (23%) had atrial fibrillation or flutter of whom 2 (6%) were newly diagnosed. Two patients (6%) had high degree atrioventricular blockade and 1 had prolonged sinus pauses, all of whom underwent placement of a permanent pacemaker (at 2-, 29- and 119-days following results, respectively). Twenty-five patients (81%) had documented non-sustained ventricular tachycardia with an average of 37.2 episodes (range of 1 to 713). No patients had an implantable cardioverter defibrillator placed.
Conclusions: In patients with ATTR-CA there is an equal prevalence of new atrial arrhythmias and significant conduction disease requiring permanent pacing. The burden of ventricular arrhythmias was significantly higher than atrial arrhythmias in this population. This is contrary to other cardiomyopathies in which atrial arrhythmias often precede ventricular arrhythmias.
Methods: This is a retrospective study of patients with ATTR-CA, who underwent long-term monitoring for cardiac arrhythmias between June 2018 and April 2021. Baseline demographics, cardiac biomarkers, New York Heart Association (NYHA) functional class assessment and arrhythmia monitor results were obtained. Gillmore stage was calculated for each patient (1 point for each of NT-proBNP >3000 pg/ml and eGFR < 45 ml/min/m2) for a range of 0 to 2 points corresponding to stages 1 to 3.
Results: Thirty-one patients with ATTR-CA who underwent long-term cardiac monitoring were included (18 with ATTRwt and 13 with ATTRv). Mean age was 77±11 years, 84% male with average NYHA class 2.2±0.7, NT-proBNP of 2,312±1977 pg/ml, hs Troponin T of 50±29 ng/L and eGFR of 53±20 ml/min/m2. Their mean Gillmore stage was 1.6±0.6. Subjects wore the monitor for an average of 13.3±2.4 days (range 2 to 14 days). Seven patients (23%) had atrial fibrillation or flutter of whom 2 (6%) were newly diagnosed. Two patients (6%) had high degree atrioventricular blockade and 1 had prolonged sinus pauses, all of whom underwent placement of a permanent pacemaker (at 2-, 29- and 119-days following results, respectively). Twenty-five patients (81%) had documented non-sustained ventricular tachycardia with an average of 37.2 episodes (range of 1 to 713). No patients had an implantable cardioverter defibrillator placed.
Conclusions: In patients with ATTR-CA there is an equal prevalence of new atrial arrhythmias and significant conduction disease requiring permanent pacing. The burden of ventricular arrhythmias was significantly higher than atrial arrhythmias in this population. This is contrary to other cardiomyopathies in which atrial arrhythmias often precede ventricular arrhythmias.
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