Frequencies and types of arrhythmias in patients with systemic light-chain amyloidosis with cardiac involvement undergoing stem cell transplantation on telemetry monitoring Journal Article


Authors: Goldsmith, Y. B.; Liu, J.; Chou, J.; Hoffman, J.; Comenzo, R. L.; Steingart, R. M.
Article Title: Frequencies and types of arrhythmias in patients with systemic light-chain amyloidosis with cardiac involvement undergoing stem cell transplantation on telemetry monitoring
Abstract: Cardiac patients with systemic light-chain amyloidosis have a high incidence of arrhythmias and arrhythmia-related death. We aimed to describe the arrhythmias, determine patient characteristics associated with the development of ventricular arrhythmias, and the utility of telemetric monitoring in patients with cardiac involvement due to AL amyloidosis undergoing stem cell transplantation (SCT). Arrhythmia events of 24 consecutive cardiac patients with AL who underwent SCT with continuous telemetric monitoring were retrospectively reviewed. The relation between number and severity of ventricular arrhythmias (ventricular tachycardia/ventricular fibrillation [VT/VF]) and baseline clinical, laboratory, and echocardiographic data were determined. Atrial and ventricular arrhythmias were found in all patients. Nonsustained VT was the most frequent event (267 total events). Therapeutic intervention for arrhythmias was required in 20 patients; in 3 patients, life-threatening arrhythmias were detected and treated. There was an inverse relation between VT/VF and cardiac output (r = -0.72, p <0.0001), cardiac index (r = -0.71, p = 0.0001), and stroke volume (r = -0.59, p = 0.0029). There was also a relation between VT/VF and brain natriuretic peptide before SCT (r = 0.47, p = 0.019) and average brain natriuretic peptide levels during admission for SCT (r = 0.62, p = 0.0012), troponin I levels at diagnosis (r = 0.47, p = 0.022), and serum creatinine levels before SCT (r = 0.62, p = 0.001). In conclusion, patients with cardiac amyloidosis undergoing SCT have a high incidence of ventricular and atrial arrhythmias; decreased cardiac output was strongly associated with significant ventricular arrhythmias. Continuous telemetric monitoring contributed to patient safety during SCT. © 2009 Elsevier Inc. All rights reserved.
Keywords: clinical article; controlled study; treatment outcome; survival rate; retrospective studies; combined modality therapy; cohort studies; creatinine; amyloidosis; creatinine blood level; stem cell transplantation; risk assessment; disease severity; severity of illness index; probability; patient safety; hospital admission; echocardiography; analysis of variance; heart atrium arrhythmia; electrocardiography; telemetry; brain natriuretic peptide; troponin i; clinical laboratory; heart amyloidosis; heart index; heart output; heart stroke volume; heart ventricle arrhythmia; heart ventricle fibrillation; heart ventricle tachycardia; anti-arrhythmia agents; arrhythmias, cardiac; cardiac output; monitoring, intraoperative; pacemaker, artificial; statistics, nonparametric; stroke volume; tachycardia, ventricular; ventricular fibrillation
Journal Title: American Journal of Cardiology
Volume: 104
Issue: 7
ISSN: 0002-9149
Publisher: Excerpta Medica Inc  
Date Published: 2009-10-01
Start Page: 990
End Page: 994
Language: English
DOI: 10.1016/j.amjcard.2009.05.040
PUBMED: 19766769
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 3" - "Export Date: 30 November 2010" - "CODEN: AJCDA" - "Source: Scopus"
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MSK Authors
  1. Joanne Fu-Lou Chou
    236 Chou
  2. Jennifer Liu
    63 Liu
  3. Raymond L Comenzo
    114 Comenzo
  4. James Edward Hoffman
    10 Hoffman
  5. Richard M Steingart
    140 Steingart