Detection of arrhythmias in patients with cardiac amyloidosis using implantable ECG recorders

Introduction

Cardiac Amyloidosis frequently results in congestive cardiac failure and arrhythmias, from a disruption in cardiac substrate with subsequent electro-mechanical remodeling. Arrhythmias are vary based on the amyloidosis type. Conduction defects and atrial arrhythmias are more prevalent in transthyretin amyloidosis compared with light chain amyloidosis, and this difference might be a reflection of the longer survival time in the former.

Methods

112 transthyretin amyloidosis (TTR) patients with completed underlying diagnosis including 99mTc-DPD scan, genetic testing and endomyocardioal biopsy (27%) without documented arrhythmias were randomized to standard clinical follow-up including arrhythmias or implantation of an ECG loop recorder (ILR). The classic FU took place in a heart failure clinic, and the group of patients with ILR was monitored by remote control with automatic daily report of the occurrence of arrhythmias by an independent organization. If an arrhythmia was detected, the patient was contacted immediately. The mean follow-up time for both groups was 17±7 months.

Results

The results are summarized in Table 1.

Conclusions

Currently, there is no consensus on the absolute benefit that ICDs in patients with cardiac amyloidosis. When non-sustained VT and syncope are captured and documented, ICD implantation for prevention of SCD in CA is most likely a reasonable approach. However, intensive monitoring of arrhythmias in patients with CA using ILR can lead to accurate and early detection of ventricular arrhythmias in particular and early initiation of ICD treatment as a prevention of SCD. Documentation of ventricular arrhythmias in CA patients was significantly higher by ILR (p<0.005) and was a clear predictor of patient survival (HR 2.51).

Funding Acknowledgement

Type of funding sources: None.

Essential role of PET-CT in the management of patients with severe infectious complication CIEDS: multicentre study

Background

With the increasing number of implanted cardiac pacemakers, ICDs and CRTs, the number of serious infectious complications of these procedures increases significantly, especially in the longer term from the primary implantation. The systematic solution is in most cases endovasal extraction of these systems.

Methods

In a multicenter, prospective, randomized, controlled trial evaluating the benefit of CIEDS infection management in 277 patients, a conventional approach using blood cultures, microbiological examinations and TEE versus innovative management of these patients using PET-CT was compared. PET-CT examination is able to differentiate very well the infection of the implant pocket (Figure A) against bacterial endocarditis (Figure B). Thanks to this, it is possible to individualize the management of the patient and to shorten the dates of hospitalization, resp. time to re-implantation of the new system in patients without the presence of bacterial endocarditis.

Results

The results of the multicentre study are summarized in Table 1.

Conclusions

A comprehensive examination of patients with CDRIE using PET-CT significantly shortens hospital stay, time of antibiotic therapy and, as a consequence, leads to a lower incidence of serious complications of extraction procedures.

PET-CT in CDRIE patients

Funding Acknowledgement

Type of funding source: None

Red or white wine consumption effect on atherosclerosis in healthy individuals (In Vino Veritas study)

AIMS

Consumption of wine has a protective effect on cardiovascular diseases. Data from prospective, long-term, head-to-head comparisons of effects of different drinks on markers of atherosclerosis have been insufficient.

METHODS AND RESULTS

In Vino Veritas (IVV) study is long-term, prospective, multi-centre, randomized trial comparing effects of red and white wine on atherosclerosis. 157 healthy subjects were randomized to white or red wine consumption for one year. We did not find increase in HDL-cholesterol in the whole group (1.66±0.58 vs 1.62±0.49, p=0.180) or difference between both groups (1.60±0.53 vs 1.64±0.46, p=0.634). At 12 months there was reduction of LDL-cholesterol in both groups, but with no difference between the groups (3.37±0.75 vs 3.60±1.10, p=0.134); there was no difference between the groups in total cholesterol, CRP, fasting blood glucose and liver function tests. Both groups had comparable differences from baseline in levels of parameters of oxidative stress.

CONCLUSION

We did not find any clinically relevant differences in the lipid profile, CRP, fasting blood glucose and other markers of atherosclerosis, between long-term consumption of red and white wine. Moreover, we were unable to confirm the hypothesis that wine drinking is associated with an elevation of HDL (Tab. 7, Fig. 1, Ref. 30).