Utilization and Prognosis of Cardiac Device Implantation in AL Versus ATTR Amyloidosis

INTRODUCTION: Cardiac amyloidosis can cause congestive heart failure, arrhythmias, and heart blocks, which frequently require cardiac device implantation (CDI). However, the differences between light chain (AL) amyloidosis and transthyretin (ATTR) amyloidosis CDI requirements are unknown. METHODS: A retrospective analysis was conducted using the National Inpatient Sample 2017-2020 with respective ICD-10 codes. Weighted multivariate regression was used to analyze in-hospital mortality by adjusting for confounders. RESULTS: Among 1,008,010 patients hospitalized for CDI, 160 patients had underlying AL-AMD, while 200 patients had underlying ATTR-AMD. Patients undergoing CDI with underlying ATTR-AMD had a higher mean age (76.7 vs. 68.4 years, p = 0.001), and a higher male proportion (80% vs. 46.8%, p = 0.005) as compared to those with AL-AMD. ATTR-AMD had a higher CDI rate than AL-AMD (1.4% vs. 8.3%). The predominant device implanted in both AL-AMD and ATTR-AMD was a permanent pacemaker (PPM) (0.8% vs. 5.7%). Underlying AL-AMD was associated with higher in-hospital mortality in patients undergoing PPM (OR 5.1, CI 1.3-19, p = 0.01), and implantable-cardioverter defibrillator (ICD) implantation (OR 21.5, CI 4.6-99, p < 0.001). Patients undergoing CDI with underlying AL-AMD had a higher mean length of stay. CONCLUSION: ATTR-AMD has a higher CDI rate as compared to AL-AMD. Underlying AL-AMD is associated with higher in-hospital mortality in patients undergoing PP and ICD implantation.