Electrocardiography and Holter monitoring in patients with Cardiac AL Amyloidosis

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Aim Cardiac amyloidosis (CA) reflects an infiltrative heart disease with poor prognosis. Aim of the study was to recognise differences between patients with and without CA in 12-lead electrocardiography (ECG) and 24hr Holter ECG monitoring and identify dependence of ECG and Holter ECG monitors on disease progression. Methods We prospectively analyzed clinical profile, echocardiographical pattern, ECG and 24hr Holter monitoring in 39 (66 (62; 71) years, 62% males) consecutive patients with AL amyloidosis screened to cardiac involvement. Results Out of all patients, CA was confirmed in 26 (67%) patients. All patients with cardiac AL amyloidosis manifested at least one pathology on ECG, what was contrast to low prevalence in patients without cardiac involvement (54%), p < 0.001. Abnormal Holter ECG was seen in 77 % and 62 % of patients with and without cardiac involvement, respectively. Patients with cardiac involvement and E/A or E/E´ ratio above median manifested higher numbers of VPBs than rest of subjects (median 195 (IQR 31; 546) vs. 6 (3; 40); p = 0.02, and 195 (31; 274) vs. 14 (5; 54); p = 0.04, respectively). During follow-up 19 (7; 59) month, 19 (73%) of patients with cardiac AL amyloidosis died. The proportion of surviving patients was higher in subjects with QRS < 100ms and QTc < 450ms (both p < 0.05). Conclusion Standard 12-lead ECG seems to be method with excellent negative predictive value for exclusion of CA. Advanced CA is associated with higher number of both premature atrial and ventricular beats. QRS and QTc duration seems to be a marker of earlier mortality of patients with CA.