BibTex format
@article{Ioannou:2026:10.1016/j.jacc.2026.04.030,
author = {Ioannou, A and Patel, R and Mansell, J and Sheikh, A and Thillainathan, B and Razvi, Y and Martinez-Naharro, A and Venneri, L and Lane, T and Petrie, A and Moon, J and Manisty, C and Lachmann, H and Hawkins, PN and Galpert, J and Keene, D and Kellman, P and Solomon, SD and Knight, DS and Kotecha, T and Lockie, T and Patel, N and Khiani, R and Wechalekar, A and Gillmore, JD and Fontana, M},
doi = {10.1016/j.jacc.2026.04.030},
journal = {J Am Coll Cardiol},
pages = {1387--1398},
title = {Exploration of Arrhythmia Burden in Cardiac Amyloidosis Using Implantable Loop Recorders: The EXCALIBUR Study.},
url = {http://dx.doi.org/10.1016/j.jacc.2026.04.030},
volume = {88},
year = {2026}
}
RIS format (EndNote, RefMan)
TY - JOUR
AB - BACKGROUND: Cardiac amyloidosis (CA) is a progressive infiltrative cardiomyopathy associated with conduction disease and arrhythmias, although their true burden and relationship with disease phenotype remain incompletely defined. OBJECTIVES: The purpose of this study was to prospectively characterize arrhythmic burden using implantable loop recorders and explore associations with amyloid subtype and disease characteristics. METHODS: In this prospective single-center observational study, 110 treatment-naïve patients with a new diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM) or light-chain cardiac amyloidosis (AL-CA) underwent comprehensive phenotyping, including cardiac magnetic resonance, followed by implantable loop recorder implantation. RESULTS: Among 110 patients (ATTRwt-CM: 43, ATTRv-CM: 20, AL-CA: 47) bradyarrhythmias with a Class I indication for pacemaker implantation occurred in 17.3% and were more frequent in ATTR-CM than AL-CA (15 [23.8%] vs 4 [8.5%]; P = 0.036). Baseline conduction abnormalities (QRS duration: sHR: 1.03; [95% CI: 1.01-1.04]; P < 0.001) and higher myocardial amyloid burden were associated with subsequent bradyarrhythmic events (ECV: sHR: 1.06 [95% CI: 1.02-1.10]; P = 0.002). New atrial fibrillation occurred in 28.2% of patients without prior atrial fibrillation and was more frequent in ATTR-CM than AL-CA (15 [50.0%] vs 5 [12.2%]; P < 0.001) with higher amyloid burden associated with increased risk (ECV: sHR: 1.04; 95% CI: 1.00-1.08; P = 0.038). During follow-up 21 (19.1%) patients died (ATTR-CM: 10 [15.9%]; AL-CA: 11[23.4%]). In patients with ATTR-CM, the terminal cardiac rhythm was uniformly pulseless electrical activity; in patients with AL-CA, PEA was the terminal rhythm in 9 (81.8%) patients and 2 (18.2%) had sustained ventricular arrhythmias. CONCLUSIONS: In CA, clinically significant arrhythmias are common and frequently asymptomatic. Arrhythmic burden and patterns differ between amyloid subtypes and are close
AU - Ioannou,A
AU - Patel,R
AU - Mansell,J
AU - Sheikh,A
AU - Thillainathan,B
AU - Razvi,Y
AU - Martinez-Naharro,A
AU - Venneri,L
AU - Lane,T
AU - Petrie,A
AU - Moon,J
AU - Manisty,C
AU - Lachmann,H
AU - Hawkins,PN
AU - Galpert,J
AU - Keene,D
AU - Kellman,P
AU - Solomon,SD
AU - Knight,DS
AU - Kotecha,T
AU - Lockie,T
AU - Patel,N
AU - Khiani,R
AU - Wechalekar,A
AU - Gillmore,JD
AU - Fontana,M
DO - 10.1016/j.jacc.2026.04.030
EP - 1398
PY - 2026///
SP - 1387
TI - Exploration of Arrhythmia Burden in Cardiac Amyloidosis Using Implantable Loop Recorders: The EXCALIBUR Study.
T2 - J Am Coll Cardiol
UR - http://dx.doi.org/10.1016/j.jacc.2026.04.030
UR - https://www.ncbi.nlm.nih.gov/pubmed/42201646
VL - 88
ER -