Right Ventricular Endocardial Mapping and a Potential Arrhythmogenic Substrate in Cardiac Amyloidosis—Role of ICD

Aleksandra Liżewska-Springer,Tomasz Królak,Grzegorz Sławiński,Alicja Dąbrowska-Kugacka,Maciej Kempa,Karolina Dorniak,Ewa Lewicka

doi:10.3390/ijerph182111631

Aleksandra Liżewska-Springer, Tomasz Królak + Show 5 more

Open Access

https://doi.org/10.3390/ijerph182111631

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Abstract

Patients with cardiac amyloidosis (CA) have an increased risk of sudden cardiac death. (SCD). However, the role of an implantable cardioverter-defibrillator in the primary prevention of SCD in this group of patients is still controversial. We present a case with CA with recurrent syncope and non-sustained ventricular tachycardia. In order to further stratify the risk of SCD, an electrophysiological study with endocardial electroanatomic voltage mapping was performed prior to the ICD placement.

Highlights

Public Health 2021, 18, We present a patient with cardiac amyloidosis (CA) resulting from clonal production of immunoglobulin light chains (AL amyloidosis), with recurrent syncope and nonsustained ventricular tachycardia, who underwent electrophysiological study with endocardial electro-anatomic voltage mapping, and was referred for implantable cardioverter-defibrillator (ICD) placement for primary prevention of sudden cardiac death (SCD)
A 51-year-old Caucasian male was admitted to the cardiology department for syncope episodes and nonsustained ventricular tachycardia (nsVT) recorded on 7-day ambulatory Holter electrocardiographic (ECG)
2019 Heart Rhythm Society consensus statement, a prophylactic ICD implantation may be considered in patients with are: immunoglobulin light chain (AL) cardiac amyloidosis and nsVT in whom the expected survival is longer than 1 year [6]

Summary

Introduction

Res. Public Health 2021, 18, We present a patient with cardiac amyloidosis (CA) resulting from clonal production of immunoglobulin light chains (AL amyloidosis), with recurrent syncope and nonsustained ventricular tachycardia (nsVT), who underwent electrophysiological study with endocardial electro-anatomic voltage mapping, and was referred for implantable cardioverter-defibrillator (ICD) placement for primary prevention of sudden cardiac death (SCD). There is an increased risk of SCD in CA patients, but other studies do not confirm that they benefit from ICD. Little is known about the pathophysiology of ventricular arrhythmias in CA patients, including invasive electrophysiological studies, which is essential for risk assessment [2]. The endocardial voltage mapping was performed for the first time, which may be important for understanding the causes of arrhythmias in these patients

History of Presentation

Past Medical History

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