Predictive markers and thresholds for pacemaker implantation in patients with ATTR amyloidosis - 08/01/26
, A. Zygouri 2, M. Bézard 3, J. Antonelli 2, S. Vesa 4, E. Donal 2Résumé |
Introduction |
Cardiac amyloidosis (CA) is increasingly acknowledged as a primary cause of conduction abnormalities such as bradyarrhythmias. However, current guidelines do not differentiate pacemaker (PM) implantation criteria for CA patients from those applied to the general population. Identifying specific indicators that predict pacing needs could aid in early risk stratification and targeted follow-up.
Objective |
To investigate clinical and imaging predictors of pacemaker implantation in transthyretin amyloidosis (ATTR) patients and to determine cutoff values that could support early identification of individuals at risk for future pacing.
Method |
We retrospectively analyzed a cohort of consecutive ATTR patients diagnosed between 2016 and 2023 at a single specialized center. Clinical, biochemical, and echocardiographic parameters were assessed. Patients with a pacemaker at the time of ATTR diagnosis ( n = 54) were excluded. The primary endpoint was new PM implantation during follow-up.
Results |
A total of 269 patients were included (median age 83 years; 84.4% male). Over a fixed 24-month follow-up, 50 patients (18.6%) underwent PM implantation, with a median time to implantation of 6 months [1.75;11.25]. The most frequent indications were complete AV block (26%), advanced conduction disorders (26%), CRT- P indication (16%), symptomatic AF with bradycardia (16%), and AF resistant to rhythm/rate control (16%).
Key factors associated with increased risk of PM implantation included a history of atrial fibrillation, QRS duration > 128 ms, LAVI > 50 ml/m 2 , IVS thickness > 18 mm, NT-proBNP > 2200 pg/ml, and E/e’ > 11. On multivariate analysis, the strongest independent predictors were QRS > 128 ms (HR 2.669, 95% CI 1.487–4.792; P < 0.001), IVS > 18 mm (HR 2.744, 95% CI 1.533–4.911), and E/e’ > 11 (HR 4.298, 95% CI 1.029–17.942).
Conclusion |
Nearly one in five ATTR patients required pacemaker implantation within two years of diagnosis. Prolonged QRS, increased septal wall thickness, and elevated E/e’ ratio emerged as robust predictors of pacing necessity, offering valuable markers for refining patient monitoring and management strategies.
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Vol 119 - N° 1S
P. S53 - janvier 2026 Retour au numéro
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