Salinas-Arce Jorge, Alca-Clares Raúl, Gonzales-Luna Ana Cecilia, Cabrera-Saldaña Mario, Mendoza-Novoa Pablo, Solórzano-Altamirano Paula, Guevara-Valdivia Milton
Unidad de Arritmias, Clínica Delgado. Lima, Perú. Unidad de Arritmias Clínica Delgado Lima Perú.
. Servicio de Cardiología, Hospital Cayetano Heredia. Lima, Perú. Servicio de Cardiología Hospital Cayetano Heredia Lima Perú.
Arch Peru Cardiol Cir Cardiovasc. 2022 Jun 27;3(2):82-97. doi: 10.47487/apcyccv.v3i2.217. eCollection 2022 Apr-Jun.
Cardiac amyloidosis (CA) is a form of cardiomyopathy characterized by the extracellular deposit of protein fibers in the myocardium, leading to the development of heart failure, arrhythmias, and electrical conduction system alterations. It is known that most cardiomyopathies have a close relationship with heart rhythm abnormalities, however, CA is specially related to different kinds of arrhythmias even in pre-diagnosis stages. Arrhythmias like atrial fibrillation are present in up to 70% of patients with CA associated with a high risk of cardioembolic complications independent of the risk stratification. Ventricular arrhythmias are frequent, but the use of implantable cardioverter defibrillator has not been demonstrated to improve survival. The Atrial-Ventricular node disease is also common, and is frequently associated with the implantation of a pacemaker, even in asymptomatic patients. In this review, we clarify the recommendations of the most current guidelines, summarize historical and contemporaneous data and describe evidence-based strategies for the management of arrhythmias and their complications in CA.
心脏淀粉样变性(CA)是一种心肌病,其特征是心肌中细胞外蛋白质纤维沉积,导致心力衰竭、心律失常和电传导系统改变。已知大多数心肌病与心律异常密切相关,然而,即使在预诊断阶段,CA也与各种心律失常特别相关。心房颤动等心律失常在高达70%的CA患者中出现,与心脏栓塞并发症的高风险相关,与风险分层无关。室性心律失常很常见,但植入式心脏复律除颤器的使用尚未被证明能提高生存率。房室结疾病也很常见,即使在无症状患者中也经常与起搏器植入相关。在本综述中,我们阐明了最新指南的建议,总结了历史和同期数据,并描述了CA中心律失常及其并发症管理的循证策略。