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Primary prevention implantable cardioverter‐defibrillators in transthyretin cardiac amyloidosis
Author(s) -
Donnellan Eoin,
Wazni Oussama M.,
Hanna Mazen,
Saliba Walid,
Jaber Wael,
Kanj Mohamed
Publication year - 2020
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.14023
Subject(s) - medicine , atrial fibrillation , ejection fraction , implantable cardioverter defibrillator , primary prevention , cardiology , cohort , sudden cardiac death , heart failure , cardiac amyloidosis , population , proportional hazards model , disease , environmental health
Background Due to the poor long‐term prognosis of patients with transthyretin cardiac amyloidosis (ATTR‐CA), the role of primary prevention implantable cardioverter‐defibrillators (ICDs) in this patient population remains controversial. We aimed to study the impact of primary prevention ICDs on survival in patients with ATTR‐CA. Methods Among 382 patients diagnosed with ATTR‐CA at our institution between 2004 and 2018, 19 had primary prevention ICDs implanted. This cohort was matched in a 1:3 manner on the basis of age, gender, ejection fraction (EF) and ATTR‐CA stage with 57 patients without cardiac devices. Patients were followed up for a mean of 23 ± 19 months. Our primary outcome of interest was all‐cause mortality. Results Mean EF at the time of ICD implantation was 28 ± 8%. No patients had a history of sustained ventricular arrhythmia (VA) at the time of implant. Only a minority of patients were tolerant of optimal medical therapy due to renal impairment, hypotension, or a combination of the two. Death occurred in 43 (75%) patients without primary prevention ICDs and 16 (84%) patients with primary prevention ICDs, P = .26. Of the 19 patients with ICDs, three had inappropriate shocks delivered for atrial fibrillation, and none had therapies for sustained VAs. On Cox proportional hazards analyses, the presence of a primary prevention ICD was not associated with improved survival (HR 0.72, 95% CI 0.4‐1.3, P = .27). Conclusion Primary prevention ICDs do not prolong survival in patients with ATTR‐CA and a reduced EF. Our findings are observational and will need to be validated in future prospective studies.