Electrocardiographic features and rhythm disorders in cardiac amyloidosis

Nicolò Martini; Giulio Sinigiani; Laura De Michieli; Roberta Mussinelli; Martina Perazzolo Marra; Sabino Iliceto; Alessandro Zorzi; Stefano Perlini; Domenico Corrado; Alberto Cipriani

doi:10.1016/j.tcm.2023.02.006

Electrocardiographic features and rhythm disorders in cardiac amyloidosis

Trends Cardiovasc Med. 2023 Feb 24:S1050-1738(23)00024-5. doi: 10.1016/j.tcm.2023.02.006. Online ahead of print.

Affiliations

¹ Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, Padua 35128, Italy.
² Amyloidosis Research and Treatment Center, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy.
³ Amyloidosis Research and Treatment Center, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy; Emergency Medicine, Vascular and Metabolic Disease Unit, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy.
⁴ Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, Padua 35128, Italy. Electronic address: alberto.cipriani@unipd.it.

PMID: 36841466
DOI: 10.1016/j.tcm.2023.02.006

Abstract

Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy caused by extracellular deposition of amyloid fibrils, mainly derived from transthyretin, either wild-type or hereditary variants, or immunoglobulin light chains misfolding. It is characterized by an increased left ventricular (LV) mass and diastolic dysfunction, which can lead to heart failure with preserved ejection fraction and/or conduction disturbances. The diagnosis is based on invasive pathology demonstration of amyloid deposits, or non-invasive criteria using advanced cardiovascular imaging techniques. Nevertheless, 12-lead electrocardiogram (ECG) remains of crucial importance in the assessment of patients with CA, since they can manifest peculiar features such as low QRS voltages, in discordance with the LV hypertrophy, but also pseudo-infarction patterns, sinus node dysfunction, atrioventricular blocks, premature supraventricular and ventricular beats, which support the presence of a myocardial disease. Great awareness of these common ECG characteristics of CA is needed to increase diagnostic performance and improve patient's outcome. In the present review, we discuss the current role of the ECG in the diagnosis and management of CA, focusing on the most common ECG abnormalities and rhythm disorders.

Keywords: Cardiac amyloidosis; Electrocardiogram; Rhythm disorders.

Publication types

Review