Cardiac resynchronization therapy demonstrated superior survival compared to high right ventricular pacing burden (≥40%) in ATTR-CM patients (HR 3.03, p=0.005).
Cohort (n=105)
Does CRT or high RVP burden affect survival and heart failure rehospitalization compared to low RVP burden in patients with ATTR-CM requiring device implantation?
In patients with ATTR-CM requiring device implantation, high right ventricular pacing burden is associated with increased mortality and HF rehospitalization, whereas upfront CRT is associated with improved survival compared to high RVP.
Estimación del efecto: HR 3.03
valor p: p=0.005
BACKGROUND Transthyretin cardiac amyloidosis (ATTR-CM) frequently affects native conduction, necessitating permanent pacemaker (PPM), implantable cardioverter-defibrillator (ICD), or cardiac resynchronization therapy (CRT) implantation. This study characterizes right ventricular pacing (RVP) burden in ATTR-CM patients and evaluates its impact on left ventricular ejection fraction (LVEF), heart failure (HF) rehospitalization, and survival. METHODS Retrospective chart review of ATTR-CM patients requiring device implantation (4/2012-9/2022). Patients were categorized by pacing burden: low RVP (pacing burden <40%, N=31), high RVP (≥40%, N=38), and CRT (N=36). Fine-Gray models were used for survival analysis; incidence rate ratios (IRRs) evaluated HF rehospitalization. Models were adjusted for age, race, gender, National Amyloidosis Center (NAC) staging, initial LVEF, and atrial fibrillation. RESULTS A total of 105 patients with mean age 80±8 years, 75% male, 67% Caucasian, were followed up for median 3.1 (IQR: 1.3-4.9) years. NAC stage II/III were more prevalent in high RVP (65%) and CRT (80%) versus low RVP (55%). High RVP showed significantly increased HF rehospitalization versus low RVP (IRR 5.76, p<0.001). CRT had higher rehospitalization than low RVP (IRR 3.35, p<0.001) but similar to high RVP (IRR 1.72, p=0.106). High RVP demonstrated worse survival versus low RVP (HR 6.24, p<0.001). CRT showed better survival than high RVP (HR 3.03, p=0.005) with no difference versus low RVP. Independent mortality predictors included NAC Stage III (HR 4.81, p<0.001), atrial fibrillation (HR 2.01, p=0.028), and lower initial LVEF (HR 1.03, p=0.006). CONCLUSION High RVP burden is associated with increased HF rehospitalization and mortality in ATTR-CM. CRT implanted upfront demonstrated superior survival compared to high RVP, suggesting a benefit for ATTR-CM patients with high pacing needs and NAC stage II/III, warranting further investigation.
Huang et al. (Sat,) conducted a cohort in Transthyretin cardiac amyloidosis (ATTR-CM) (n=105). Cardiac resynchronization therapy (CRT) or High right ventricular pacing (RVP ≥40%) vs. Low RVP (<40%) was evaluated on Survival (HR 3.03, p=0.005). Cardiac resynchronization therapy demonstrated superior survival compared to high right ventricular pacing burden (≥40%) in ATTR-CM patients (HR 3.03, p=0.005).