Aouate David, Menet Aymeric, Bellevre Dimitri, Damy Thibaud, Marechaux Sylvestre
Cardiology Department, GCS-Groupement des Hôpitaux de l'Institut Catholique Lillois/Faculté de médecine et de maïeutique, UCLille, F-59000 Lille, France.
Department of Nuclear Medicine, UF 5881, Groupement des Hôpitaux de l'Institut Catholique de Lille, Hôpital Saint Philibert rue du grand but, 59160 Lomme, France.
Eur Heart J Case Rep. 2020 May 1;4(3):1-5. doi: 10.1093/ehjcr/ytaa088. eCollection 2020 Jun.
Cardiac amyloidosis involvement is associated with a detrimental outcome including frequent arrhythmias, heart failure, and conduction disturbances which may need permanent pacing.
We report two cases of patients with transthyretin amyloidosis (ATTR) who developed heart failure and depressed left ventricular ejection fraction (LVEF) following permanent right ventricular (RV) pacing but highly responded to cardiac resynchronization therapy (CRT).
The impact of RV pacing and CRT in cardiac amyloidosis is not known. In our cases, the detrimental effect of permanent RV pacing on left ventricular (LV) systolic function and heart failure symptoms was suggested by both permanent RV pacing mediated functional and LV function decline and LV systolic dysfunction reversal following CRT along with QRS width reduction. Whether cardiac resynchronization should be readily recommended in ATTR patients who need ventricular pacing whatever the LVEF deserves further investigation.
心脏淀粉样变性累及与不良预后相关，包括频繁心律失常、心力衰竭和传导障碍，可能需要永久起搏。
我们报告两例转甲状腺素蛋白淀粉样变性（ATTR）患者，在永久性右心室（RV）起搏后发生心力衰竭且左心室射血分数（LVEF）降低，但对心脏再同步治疗（CRT）反应良好。
RV起搏和CRT对心脏淀粉样变性的影响尚不清楚。在我们的病例中，永久性RV起搏介导的功能和左心室功能下降以及CRT后左心室收缩功能障碍逆转伴QRS波宽度减小提示永久性RV起搏对左心室（LV）收缩功能和心力衰竭症状有不良影响。对于无论LVEF如何都需要心室起搏的ATTR患者是否应立即推荐心脏再同步治疗值得进一步研究。
