Abstract
Cardiac involvement in amyloidosis and sarcoidosis is poorly understood, and is associated with high morbidity and mortality. Atrial and ventricular arrhythmias, along with conduction defects, are frequent in cardiac amyloidosis and sarcoidosis. Atrial dysfunction in cardiac amyloidosis may result in atrial fibrillation and increases the risk of stroke, making anticoagulation significant and challenging. Ventricular arrhythmia and conduction defects are more common in AL amyloidosis and cardiac sarcoidosis. Premature ventricular contractions (PVCs) from Purkinje fibers trigger ventricular arrhythmias in cardiac amyloidosis, while the inflammation and scarring leading to the reentrant process is the cause in cardiac sarcoidosis. The typical treatment modalities include Class II and III antiarrhythmic drugs and ablation techniques, while corticosteroids and immunosuppressants are indicated in cardiac sarcoidosis to reduce the burden of the disease and arrhythmias. Sudden cardiac death can be a manifestation of both disorders that can be prevented by the Implantable cardioverter-defibrillator (ICD), although the predictive risk factors for primary prevention remain uncertain. In this review, we addressed the current understanding of the pathways involved in inducing arrhythmias in cardiac amyloidosis and sarcoidosis-also, the complications including sudden death and stroke associated with arrhythmia in both diseases. We have discussed other preventive steps needed to minimize arrhythmias to provide symptomatic relief and palliation to patients.
Highlights
BackgroundCardiac amyloidosis (CA) and sarcoidosis are typically known as infiltrative cardiomyopathies
Arrhythmias in cardiac amyloidosis vary by amyloidosis type, as conduction defects and supraventricular arrhythmias are more prevalent in transthyretin amyloidosis [5]
This review aims to address the cause, relationship, and complications of arrhythmias, based on the most current data, in cardiac amyloidosis and sarcoidosis
Summary
Cardiac amyloidosis (CA) and sarcoidosis are typically known as infiltrative cardiomyopathies. This cardiac disease typically progresses from localized inflammation to scarring, resulting in atrial and ventricular arrhythmias. A recent study has shown that ventricular conduction and repolarization defects are higher in AL relative to ATTR amyloidosis [30] Conduction abnormalities such as atrioventricular conduction delay are more common than sinus node disease, despite the frequent atrial involvement in CA. Appropriate ICD shocks were more frequent in patients with prior sudden cardiac arrest or sustained ventricular arrhythmias. ICD is recommended in patients with a permanent pacemaker indication due to atrioventricular blocks (AVBs)
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