48 Utilisation of cardiac implantable electronic device therapy in patientswith attr-wild type amyloidosis with concurrent cardiac involvement

Introduction The role of cardiac implantable electronic device (CIED) therapy in patients with ATTR-wt (senile) amyloid is not very well defined. It is unknown whether there is mortality benefit or harm with the implantation of CIEDs. Methods We performed a retrospective analysis of a prospectively collected registry of patients with biopsy proven ATTR-wt amyloid with cardiac involvement. These patients were followed up at Mayo Clinic, Rochester, Minnesota between Jan 1, 1985 to Sep 30, 2015. The follow-up of these patients was done via personal communication (written or verbal) and entered into the database. During analysis these patients were subdivided on the basis of the presence or absence of a CIED, cardiac involvement or not, and all-cause mortality analysed. The implantation of a CIED was analysed as a time-dependent covariate in the survival of these patients and Kaplan-Meier (K-M) survival plots created. Comparison between groups with CIED and those without CIED was made. In addition, CIEDs were subdivided into permanent pacemakers (PPM), defibrillators (ICDs) and cardiac resynchronization devices (CRT-P/D). Mortality among the patients with each device subtype was estimated and compared to overall mortality. Results 409 patients with ATTR-wt and cardiac involvement were reviewed with CIEDs implanted in 101 (25%) patients. The median follow-up (25th, 75th centile) was 2.4 (1.1, 4.3) years. Utilisation of ICDs in this population was higher than the general community in Olmsted county. There was no association in the overall survival or evidence of harm with CIED utilisation in patients with ATTR amyloidosis and cardiac involvement. Conclusions CIEDs utilisation remains high in ATTR-wt with cardiac involvement. Due diligence is needed in selecting the optimal patient for benefit prior to the implantation of CIEDs in this cohort. Further research is required to pool multi-centre amyloid registry data and determine if there is mortality benefit.