![]() Clinical features and predictors of atrial fibrillation in patients with light-chain or transthyretin cardiac amyloidosis. Atrial fibrillation and subtype of atrial fibrillation in cardiac amyloidosis: Clinical and echocardiographic features, impact on mortality. Clinical Importance of Left Atrial Infiltration in Cardiac Transthyretin Amyloidosis. Brief report: Atrial systolic failure in primary amyloidosis. Systemic cardiac amyloidoses: Disease profiles and clinical courses of the 3 main types. Ventricular tachyarrhythmias and sudden cardiac death in light-chain amyloidosis: A clash of cardio-toxicities? Br. Features of atrial fibrillation in wild-type transthyretin cardiac amyloidosis: A systematic review and clinical experience. Pathophysiology and Therapeutic Approaches to Cardiac Amyloidosis. Noncontrast Magnetic Resonance for the Diagnosis of Cardiac Amyloidosis. Echocardiographic phenotype and prognosis in transthyretin cardiac amyloidosis. Wild-type transthyretin amyloidosis as a cause of heart failure with preserved ejection fraction. Atrioventricular Conduction DiseasesĪF = atrial fibrillation AL = light-chain amyloidosis ATTR = transthyretin-related amyloidosis AVN = atrioventricular node CA = cardiac amyloidosis CMR = cardiac magnetic resonance DCCV = direct current cardioversion HV = Hiss-ventricle HF = heart failure HFpEF = heart failure with preserved ejection fraction ICD = implantable cardioverter defibrillator INR = international normalized ratio LA = left atrium LV = left ventricle NOACs = novel oral anticoagulants NSVT = non-sustained ventricular tachycardias NYHA = New York Heart Association PEA = pulseless electrical activity PM = pacemaker SR = sinus rhythm TEE = transesophageal echocardiography TIA = transient ischemic attacks VAs = ventricular arrhythmias VKA = vitamin K antagonist VT = ventricular tachycardia wtATTR = wild-type transthyretin-related amyloidosis. Moreover, the presence of AF in both solely HFpEF and CA may worsen HF symptoms, probably due to the loss of LV filling mediated by the atrial kick. As happens in CA, the presence of diastolic dysfunction and elevated LV filling pressure contributes to LA enlargement and electrical remodeling and eventually leads to AF. Furthermore, HFpEF and AF feed off each other. While in CA, the deposition of amyloid fibrils plays a pivotal role, in patients with solely HFpEF, systemic inflammation and metabolic disorders may lead to microvascular dysfunction and fibrosis of both atria and ventricles, which in turn trigger diastolic dysfunction and AF. As in cardiac amyloidosis, AF and HFpEF are manifestations of a common atrial and ventricular myopathy. Furthermore, as we have seen in wtATTR, two-thirds of patients with solely HFpEF experience AF over time. Indeed, patients with AF present a 4.8 times higher risk of developing HFpEF compared to patients in sinus rhythm, and the prevalence of AF in HFpEF is high, ranging between 15% and 41%. ![]() In these cases, we actively try to identify evidence for anticoagulation treatment, i.e., reducing the interval between Holter ECG evaluations, implanting a loop recorder or providing a home monitoring device for patients with a pacemaker or ICD, and, when renal function allows us, we repeat cardiac magnetic resonance with the aim of atrial thrombus identification.Ītrial fibrillation and HFpEF are strictly related and considered “vicious twins”. These conditions raise many concerns about the risk of thrombus formation. In a few patients, these features are associated with the presence of a clear P wave on the electrocardiogram (in the absence of a clinical history of AF). Atrial standstill might be defined by the absence of mechanical activity in the atria, as assessed visually at echocardiography, or by using atrial strain, and it might be associated with the presence of a low mitral inflow A-wave amplitude. During follow-up evaluation, it is not infrequent to identify patients presenting severe atrial enlargement or “atrial standstill” or the presence of spontaneous echo contrast within the atria at echocardiography. ![]()
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