Monitoring for arrhythmia in transthyretin cardiac amyloidosis with noninvasive ambulatory patch devices

Background: Transthyretin cardiac amyloidosis (ATTR-CA) is associated with an increased incidence of arrhythmias. We hypothesized that 2-week noninvasive ambulatory cardiac rhythm monitoring of patients with ATTR-CA would detect high rates of atrial fibrillation/atrial flutter (AF/AFL) and nonsustained ventricular tachycardia (NSVT). Objective: The study sought to characterize arrhythmia in patients with ATTR-CA on 2-week, noninvasive cardiac rhythm monitors. Methods: A total of 38 patients with ATTR-CA who underwent 2-week remote external patch monitoring were included in this single-center retrospective study. An age-matched control group included 38 patients who underwent the same cardiac rhythm monitoring as part of neurological workup. Results: Of the ATTR-CA cohort, 26.3% had AF/AFL and 81.6% had NSVT. ATTR-CA was associated with higher rates of AF/AFL and NSVT compared with the control group. At a median follow-up of 45 weeks, there was no association between the presence of AF/AFL or NSVT on remote monitor in the ATTR-CA group and a composite of adverse clinical outcome. Conclusion: ATTR-CA was associated with an elevated rate of AF/AFL and an even higher rate of NSVT on noninvasive ambulatory monitors. While evidence regarding the management of arrhythmias, particularly NSVT/ventricular tachycardia, in ATTR-CA remains limited, 2-week noninvasive cardiac monitoring can be considered to aid in risk stratification for both atrial and ventricular arrhythmias.