Alteraciones electrocardiográficas y necesidad de marcapasos en amiloidosis cardiaca: análisis de 58 casos / Electrocardiographic features and need for pacemaker in cardiac amyloidosis: Analysis of 58 cases

ObjetivoEn la amiloidosis cardiaca (AC) el material amiloide puede depositarse en diferentes estructuras cardiacas pudiendo producir diferentes alteraciones electrocardiográficas. El objetivo fue describir qué alteraciones electrocardiográficas son más frecuentes en pacientes con AC, analizando su impacto en la necesidad de marcapasos.MetodosEstudio retrospectivo que incluye pacientes diagnosticados de AC por cadenas ligeras (AC-AL) y AC por transtirretina (AC-TTR), entre enero-2013 y marzo-2021. Se analizó el ritmo basal, el porcentaje con patrón de seudoinfarto, bajo voltaje o alteraciones de la conducción; también se analizó el impacto en la necesidad de marcapasos definitivo.ResultadosSe incluyeron 58 pacientes con AC (20 AC-AL, 38 AC-TTR). Varones (69%), 21 (36%) tenían FA al diagnóstico. El 60% tenía patrón de seudoinfarto, el 35% bajo voltaje y un 22% tenían criterios de hipertrofia ventricular. Dos tercios tenían algún trastorno de conducción: bloqueo auriculoventricular de primer grado, 18 pacientes (31%); 12 bloqueo completo de rama derecha (BCRD), 3 bloqueo completo de rama izquierda (BCRI) y 25 con un hemibloqueo de rama. No hubo diferencias entre AC-AL y AC-TTR. Los pacientes con AC-TTR tuvieron mayor necesidad de marcapasos en el seguimiento (39±40 meses). El bloqueo completo de rama (BCR) fue un predictor de necesidad de marcapasos permanente (HR: 23,43; IC 95%: 4,09-134,09; p=0,01).ConclusionesLas alteraciones electrocardiográficas en pacientes diagnosticados de AC son heterogéneas, siendo la más frecuente la presencia de trastornos de conducción, el patrón de seudoinfarto, seguido del de bajo voltaje. Los pacientes con cualquier BCR en el electrocardiograma basal son más propensos a precisar marcapasos en el seguimiento, sobre todo en AC-TTR. (AU)

AimAmyloidosis is a disease in which amyloid fibrils can be deposited in different cardiac structures, and several electrocardiographic abnormalities can be produced by this phenomenon. The objective of this study was to describe the most common basal electrocardiographic alterations in patients diagnosed with cardiac amyloidosis (CA) and to determine if these abnormalities have an impact on the need of pacemaker.MethodsThis retrospective study included patients who had an established diagnosis of CA [light-chain cardiac amyloidosis (LA-CA) or transthyretin cardiac amyloidosis (TTR-CA)] between January 2013 and March 2021. The baseline heart rate, the percentage of patients with a pseudo-infarct pattern, low-voltage pattern or cardiac conductions disturbances, and the impact of these factors on the need of pacemaker were analysed.ResultsFifty-eight patients with CA (20 with LA-CA and 38 with TTR-CA) were included, and the majority were male (69.0%). Twenty-one patients had atrial fibrillation (AF) at diagnosis. Thirty-five patients had a pseudo-infarct pattern, 35% had a low-voltage pattern, and 22% had criteria for ventricular hypertrophy. Two hirds had a conduction disorder: 18 patients with first degree atrioventricular block, 12 right bundle branch block, 3 left bundle branch block and 25 with a branch hemiblock. There were no differences between LA-CA and TTR-CA. Patients with TTR-CA had a greater need for pacemakers in the folow-up (39±40 meses). Bundle branch block was a predictor of the need for a permanent pacemaker (HR: 23.43; CI 95%: 4.09.134.09; P=.01).ConclusionsElectrocardiographic abnormalities in patients diagnosed wich CA are heterogeneus. Most frecuent is the presence of conduction disorders, the pseudoinfarction pattern, followed by the low voltage pattern. Patients with any bundle branch block at the baseline electrocardiogram need more frecuent to require a pacemaker during follow-up, especially in TTR-CA. (AU)

Electrocardiographic features and need for pacemaker in cardiac amyloidosis: Analysis of 58 cases. / Alteraciones electrocardiográficas y necesidad de marcapasos en amiloidosis cardiaca: análisis de 58 casos.

AIM: Amyloidosis is a disease in which amyloid fibrils can be deposited in different cardiac structures, and several electrocardiographic abnormalities can be produced by this phenomenon. The objective of this study was to describe the most common basal electrocardiographic alterations in patients diagnosed with cardiac amyloidosis (CA) and to determine if these abnormalities have an impact on the need of pacemaker. METHODS: This retrospective study included patients who had an established diagnosis of CA [light-chain cardiac amyloidosis (LA-CA) or transthyretin cardiac amyloidosis (TTR-CA)] between January 2013 and March 2021. The baseline heart rate, the percentage of patients with a pseudo-infarct pattern, low-voltage pattern or cardiac conductions disturbances, and the impact of these factors on the need of pacemaker were analysed. RESULTS: Fifty-eight patients with CA (20 with LA-CA and 38 with TTR-CA) were included, and the majority were male (69.0%). Twenty-one patients had atrial fibrillation (AF) at diagnosis. Thirty-five patients had a pseudo-infarct pattern, 35% had a low-voltage pattern, and 22% had criteria for ventricular hypertrophy. Two hirds had a conduction disorder: 18 patients with first degree atrioventricular block, 12 right bundle branch block, 3 left bundle branch block and 25 with a branch hemiblock. There were no differences between LA-CA and TTR-CA. Patients with TTR-CA had a greater need for pacemakers in the folow-up (39±40 meses). Bundle branch block was a predictor of the need for a permanent pacemaker (HR: 23.43; CI 95%: 4.09.134.09; P=.01). CONCLUSIONS: Electrocardiographic abnormalities in patients diagnosed wich CA are heterogeneus. Most frecuent is the presence of conduction disorders, the pseudoinfarction pattern, followed by the low voltage pattern. Patients with any bundle branch block at the baseline electrocardiogram need more frecuent to require a pacemaker during follow-up, especially in TTR-CA.

Respuesta: Abordaje quirúrgico en el fracaso de la terapia de resincronización cardiaca por vía intravascular / Reply: Surgical approach to endovascular cardiac resynchronisation after failure

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Caracterización del paciente hiperrespondedor a la terapia de resincronización cardiaca / Characterization of hyper-responder patients to cardiac resynchronization therapy

Fundamento y objetivo: Comparar las características clínicas y ecocardiográficas de los hiperrespondedores a la terapia de resincronización cardiaca (TRC) frente al resto. Pacientes y método: Incluimos a 80 pacientes consecutivos tratados con TRC y un seguimiento de 19±14 meses. Definimos hiperrrespondedores a los que al final del seguimiento presentaban una fracción de eyección del ventrículo izquierdo (FEVI) ≥ 50%. Resultados: Doce (15%) fueron hiperrespondedores. Sus características clínicas basales eran similares a las del resto, excepto en que había menos varones hiperrespondedores. En estos pacientes, el diámetro diastólico basal del ventrículo izquierdo fue de 64 (7) mm y el sistólico de 55 (6) mm frente a 75 (8) mm y 66 (9) mm respectivamente, p<0,05. El área de regurgitación mitral basal en los hiperrespondedores fue de 3,1 (1,8) cm2 frente a 6,4 (5,5) cm2, p<0,05.Conclusiones: Los hiperrespondedores suelen ser mujeres que presentan basalmente un ventrículo izquierdo menos dilatado y una menor insuficiencia mitral valorada por ecocardiografía (AU)

Background and objective: To compare clinical and echocardiographic characteristics of the hyper-responders to cardiac resynchronization therapy (CRT) with the rest of patients. Patients and method: We included 80 consecutive patients treated with CRT. The follow up was 19 (14) months. Patients were considered hyper-responder if they had an ejection fraction of left ventricle (LVEF) ≥ 50% after follow up.Results: Twelve (15%) patients were considered hyper-responders. Their baseline clinical characteristics were similar to the rest except that there were fewer males in the group of hyper-responders. In these patients, basal left ventricle diastolic diameter was 64 (7) mm and the systolic was 55 (6) mm versus 75 (8) mm and 66 (9) mm respectively, p<0.05. The basal area of mitral regurgitation in the hyper-responders was 3.1 (1.8) cm2 versus 6.4 (5.5) cm2, p<0.05.Conclusions: Hyper-responder patients are often women with less dilated left ventricle and reduced severity of mitral regurgitation assessed by echocardiography (AU)

[Characterization of hyper-responder patients to cardiac resynchronization therapy]. / Caracterización del paciente hiperrespondedor a la terapia de resincronización cardiaca.

BACKGROUND AND OBJECTIVE: To compare clinical and echocardiographic characteristics of the hyper-responders to cardiac resynchronization therapy (CRT) with the rest of patients. PATIENTS AND METHOD: We included 80 consecutive patients treated with CRT. The follow up was 19 (14) months. Patients were considered hyper-responder if they had an ejection fraction of left ventricle (LVEF) ≥ 50% after follow up. RESULTS: Twelve (15%) patients were considered hyper-responders. Their baseline clinical characteristics were similar to the rest except that there were fewer males in the group of hyper-responders. In these patients, basal left ventricle diastolic diameter was 64 (7) mm and the systolic was 55 (6) mm versus 75 (8) mm and 66 (9) mm respectively, p < 0.05. The basal area of mitral regurgitation in the hyper-responders was 3.1 (1.8) cm(2) versus 6.4 (5.5) cm(2), p < 0.05. CONCLUSIONS: Hyper-responder patients are often women with less dilated left ventricle and reduced severity of mitral regurgitation assessed by echocardiography.

Seudoaneurismas en el autoinjerto pulmonar tras la cirugía de Ross / Pseudoaneurysm of the pulmonary autograft following the Ross procedure

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