Article Text
Abstract
Background Transthyretin amyloidosis cardiomyopathy (ATTR-CM) is an infiltrative cardiac disorder caused by deposition of wild type or mutated transthyretin and which is amenable to therapy with TTR stabilisers. As ATTR-CM is associated with conduction disease, we sought to determine its prevalence in patients with idiopathic high-degree atrioventricular (AV) block requiring permanent pacemaker (PPM) implantation.
Methods Consecutive patients aged 70-85 years undergoing PPM implantation for idiopathic high-degree AV block between November 2019 and November 2021 were offered a 3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) scan. Demographics, comorbidities, electrocardiographic and imaging data from the time of device implantation were retrospectively collected.
Results Thirty nine patients (79.5% male, mean (SD) age at device implantation 76.2 (2.9) years) had a DPD scan (Table 1). Three (7.7%, all male) had a result consistent with ATTR-CM (Perugini grade 2 or 3). Mean (SD) maximum wall thickness of those with a positive DPD scan was 19.0 mm (3.6 mm) versus 11.4 mm (2.7 mm) in those with a negative scan (p value = 0.06). All patients diagnosed with ATTR-CM had spinal canal stenosis and 2 had carpal tunnel syndrome.
Conclusions ATTR-CM should be considered in older patients requiring permanent pacing for high-degree AV block, particularly in the presence of left ventricular hypertrophy, carpal tunnel syndrome or spinal canal stenosis.
Conflict of Interest None