Predictors and outcomes of pacemaker implantation in patients with cardiac amyloidosis
© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ..
OBJECTIVE: We sought to investigate prevalence, incidence and prognostic implications of permanent pacemaker (PPM) implantation in patients with cardiac amyloidosis (CA), thereby identifying the predictors of time to PPM implantation.
METHODS: Seven hundred eighty-seven patients with CA (602 men, median age 74 years, 571 transthyretin amyloidosis (ATTR), 216 light-chain amyloidosis (AL)) evaluated at two European referral centres were retrospectively included. Clinical, laboratory and instrumental data were analysed. The associations between PPM implantation and mortality, heart failure (HF) or a composite endpoint of mortality, cardiac transplantation and HF were analysed.
RESULTS: 81 (10.3%) patients had a PPM before initial evaluation. Over a median follow-up time of 21.7 months (IQR 9.6-45.2), 81 (10.3%) additional patients (18 with AL (22.2%) and 63 with ATTR (77.8%)) underwent PPM implantation with a median time to implantation of 15.6 months (IQR 4.2-40), complete atrioventricular block was the most common indication (49.4%). Independent predictors of PPM implantation were QRS duration (HR 1.03, 95% CI 1.02 to 1.03, p<0.001) and interventricular septum (IVS) thickness (HR 1.1, 95% CI 1.03 to 1.17, p=0.003). The model to estimate the probability of PPM at 12 months and containing both factors showed a C-statistic of 0.71 and a calibration of slope of 0.98.
CONCLUSIONS: Conduction system disease requiring PPM is a common complication in CA that affects up to 20.6% of patients. QRS duration and IVS thickness are independently associated with PPM implantation. A PPM implantation at 12 months model was devised and validated to identify patients with CA at higher risk of requiring a PPM and who require closer follow-up.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:110 |
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| Enthalten in: |
Heart (British Cardiac Society) - 110(2023), 1 vom: 15. Dez., Seite 40-48 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Saturi, Giulia [VerfasserIn] |
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| Links: |
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| Themen: |
Cardiomyopathy, Restrictive |
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| Anmerkungen: |
Date Completed 18.12.2023 Date Revised 18.12.2023 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1136/heartjnl-2022-322315 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM359156320 |
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| 245 | 1 | 0 | |a Predictors and outcomes of pacemaker implantation in patients with cardiac amyloidosis |
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| 500 | |a Date Revised 18.12.2023 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a OBJECTIVE: We sought to investigate prevalence, incidence and prognostic implications of permanent pacemaker (PPM) implantation in patients with cardiac amyloidosis (CA), thereby identifying the predictors of time to PPM implantation | ||
| 520 | |a METHODS: Seven hundred eighty-seven patients with CA (602 men, median age 74 years, 571 transthyretin amyloidosis (ATTR), 216 light-chain amyloidosis (AL)) evaluated at two European referral centres were retrospectively included. Clinical, laboratory and instrumental data were analysed. The associations between PPM implantation and mortality, heart failure (HF) or a composite endpoint of mortality, cardiac transplantation and HF were analysed | ||
| 520 | |a RESULTS: 81 (10.3%) patients had a PPM before initial evaluation. Over a median follow-up time of 21.7 months (IQR 9.6-45.2), 81 (10.3%) additional patients (18 with AL (22.2%) and 63 with ATTR (77.8%)) underwent PPM implantation with a median time to implantation of 15.6 months (IQR 4.2-40), complete atrioventricular block was the most common indication (49.4%). Independent predictors of PPM implantation were QRS duration (HR 1.03, 95% CI 1.02 to 1.03, p<0.001) and interventricular septum (IVS) thickness (HR 1.1, 95% CI 1.03 to 1.17, p=0.003). The model to estimate the probability of PPM at 12 months and containing both factors showed a C-statistic of 0.71 and a calibration of slope of 0.98 | ||
| 520 | |a CONCLUSIONS: Conduction system disease requiring PPM is a common complication in CA that affects up to 20.6% of patients. QRS duration and IVS thickness are independently associated with PPM implantation. A PPM implantation at 12 months model was devised and validated to identify patients with CA at higher risk of requiring a PPM and who require closer follow-up | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Cardiomyopathy, Restrictive | |
| 650 | 4 | |a Pacemaker, Artificial | |
| 700 | 1 | |a De Frutos, Fernando |e verfasserin |4 aut | |
| 700 | 1 | |a Sguazzotti, Maurizio |e verfasserin |4 aut | |
| 700 | 1 | |a Gonzalez-Lopez, Esther |e verfasserin |4 aut | |
| 700 | 1 | |a Nardi, Elena |e verfasserin |4 aut | |
| 700 | 1 | |a Domínguez, Fernando |e verfasserin |4 aut | |
| 700 | 1 | |a Ponziani, Alberto |e verfasserin |4 aut | |
| 700 | 1 | |a Cabrera, Eva |e verfasserin |4 aut | |
| 700 | 1 | |a Caponetti, Angelo Giuseppe |e verfasserin |4 aut | |
| 700 | 1 | |a Lozano, Sara |e verfasserin |4 aut | |
| 700 | 1 | |a Massa, Paolo |e verfasserin |4 aut | |
| 700 | 1 | |a Cobo-Marcos, Marta |e verfasserin |4 aut | |
| 700 | 1 | |a Accietto, Antonella |e verfasserin |4 aut | |
| 700 | 1 | |a Castro-Urda, Victor |e verfasserin |4 aut | |
| 700 | 1 | |a Giovannetti, Alessandro |e verfasserin |4 aut | |
| 700 | 1 | |a Toquero, Jorge |e verfasserin |4 aut | |
| 700 | 1 | |a Gagliardi, Christian |e verfasserin |4 aut | |
| 700 | 1 | |a Gómez-Bueno, Manuel |e verfasserin |4 aut | |
| 700 | 1 | |a Rios-Tamayo, Rafael |e verfasserin |4 aut | |
| 700 | 1 | |a Biagini, Elena |e verfasserin |4 aut | |
| 700 | 1 | |a Segovia, Javier |e verfasserin |4 aut | |
| 700 | 1 | |a Galiè, Nazzareno |e verfasserin |4 aut | |
| 700 | 1 | |a García-Pavía, Pablo |e verfasserin |4 aut | |
| 700 | 1 | |a Longhi, Simone |e verfasserin |4 aut | |
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