Cardiac amyloidosis treated with an implantable cardioverter defibrillator and subcutaneous array lead system: report of a case and literature review.
BACKGROUND
Preventing ventricular arrhythmias in patients with cardiac amyloidosis is challenging since the amyloid protein deposition in the myocardium may interfere with the normal cardiac electric excitation. Most of these patients succumb to either progressive congestive heart failure, or sudden cardiac death (SCD). Implantable cardioverter defibrillator (ICD) offers a near sure means of preventing SCD.


OBJECTIVE
Myocardial infiltration with amyloid results in elevated defibrillation threshold (DFT). Intra-operative strategies may fail to lower DFT during implantation.


METHODS
We present a case of a 64-year-old female who had cardiac amyloidosis, and was successfully treated with an ICD and a subcutaneous array lead system.


CONCLUSIONS
A subcutaneous array lead system is useful in reducing the DFT, and can terminate ventricular tachycardia or fibrillation by allowing more energy delivery and efficient defibrillation.
Dhoble
Abhijeet
A
Thoracic and Cardiovascular Institute, Michigan State University, Lansing, Michigan 48823, USA.
Khasnis
Atul
A
Olomu
Adesuwa
A
Thakur
Ranjan
R
D000686:Amyloidosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000209:etiology / Q000628:therapy*