Frequencies and Types of Arrhythmias in Patients With Systemic Light-Chain Amyloidosis With Cardiac Involvement Undergoing Stem Cell Transplantation on Telemetry Monitoring

Yuliya B. Goldsmith, Jennifer Liu, Joanne Chou, James E Hoffman, Raymond L. Comenzo, Richard M. Steingart

Research output: Contribution to journalArticle

25 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)990-994
Number of pages5
JournalAmerican Journal of Cardiology
Volume104
Issue number7
DOIs
StatePublished - Oct 1 2009
Externally publishedYes

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Telemetry
Stem Cell Transplantation
Amyloidosis
Cardiac Arrhythmias
Light
Ventricular Fibrillation
Ventricular Tachycardia
Brain Natriuretic Peptide
Cardiac Output
Troponin I
Incidence
Physiologic Monitoring
Patient Safety
Stroke Volume
Creatinine

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Frequencies and Types of Arrhythmias in Patients With Systemic Light-Chain Amyloidosis With Cardiac Involvement Undergoing Stem Cell Transplantation on Telemetry Monitoring. / Goldsmith, Yuliya B.; Liu, Jennifer; Chou, Joanne; Hoffman, James E; Comenzo, Raymond L.; Steingart, Richard M.

In: American Journal of Cardiology, Vol. 104, No. 7, 01.10.2009, p. 990-994.

Research output: Contribution to journalArticle

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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.",
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