Atrioventricular sequential pacing in cardiac amyloidosis: an acute Doppler echocardiographic and catheterization hemodynamic study.
OBJECTIVE
Congestive heart failure due to cardiac amyloidosis is often refractory to conventional medical management and is associated with a high mortality rate. Recently, dual-chamber pacemaker implantation has been proposed as a therapeutic option in the management of patients with certain forms of cardiomyopathy with persistent heart failure symptoms, despite optimal medical therapy. The present study evaluates the acute hemodynamic response to atrioventricular (AV) pacing in patients with cardiac amyloidosis who presented with refractory heart failure symptoms.


METHODS
Three patients with medically refractory heart failure due to cardiac involvement of amyloidosis underwent a simultaneous cardiac catheterization/Doppler echocardiography study with acute AV sequential pacing at varying AV intervals.


RESULTS
During pacing at various AV intervals, all patients showed an increased in their filling pressures and either no change or decline in their cardiac index.


CONCLUSIONS
The current study demonstrates an absence of acute hemodynamic with AV sequential pacing in patients with amyloid heart disease and medically refractory heart failure symptoms.
Mathew
V
V
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Chaliki
H
H
Nishimura
R A
RA
D000368:Aged; D000369:Aged, 80 and over; D000686:Amyloidosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D015150:Echocardiography, Doppler; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged