Atrioventricular Sequential Pacing in Cardiac Amyloidosis: An Acute Doppler Echocardiographic and Catheterization Hemodynamic Study

Background and hypothesis: 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 increase in their filling pressures and either no change or decline in their cardiac index. Conclusion: The current study demonstrates an absence of acute hemodynamic benefit with AV sequential pacing in patients with amyloid heart disease and medically refractory heart failure symptoms.