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Study of indications for cardiac device implantation and utilisation in Fabry cardiomyopathy.

Authors
  • Vijapurapu, Ravi1, 2, 3
  • Geberhiwot, Tarekegn4, 5
  • Jovanovic, Ana6
  • Baig, Shanat1, 2, 3
  • Nordin, Sabrina7
  • Kozor, Rebecca8
  • Leyva, Francisco9
  • Kotecha, Dipak1, 2
  • Wheeldon, Nigel10
  • Deegan, Patrick11
  • Rusk, Rosemary A12
  • Moon, James C7
  • Hughes, Derralynn A13
  • Woolfson, Peter14
  • Steeds, Richard P1, 2
  • 1 Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
  • 2 Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
  • 3 Department of Endocrinology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
  • 4 Department of Endocrinology, Queen Elizabeth Hospital Birmingham, Birmingham, UK [email protected]
  • 5 Institute of Metabolism and System Research, University of Birmingham, Birmingham, UK.
  • 6 Mark Holland Metabolic Unit, Salford Royal Hospitals NHS Trust, Salford, UK.
  • 7 Department of Cardiology, Barts Heart Centre, London, UK.
  • 8 Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia. , (Australia)
  • 9 Aston Medical Research Institute, Aston Medical School, Birmingham, UK.
  • 10 South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, UK.
  • 11 Department of Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
  • 12 Department of Cardiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
  • 13 Lysosomal Storage Disorder Unit, Royal Free London NHS Foundation Trust, London, UK.
  • 14 Department of Cardiology, Salford Royal Hospitals NHS Trust, Salford, UK.
Type
Published Article
Journal
Heart
Publisher
BMJ
Publication Date
Dec 01, 2019
Volume
105
Issue
23
Pages
1825–1831
Identifiers
DOI: 10.1136/heartjnl-2019-315229
PMID: 31446426
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Fabry disease is a treatable X-linked condition leading to progressive cardiomyopathy, arrhythmia and premature death. Atrial and ventricular arrhythmias contribute significantly to adverse prognosis; however, guidance to determine which patients require cardiovascular implantable electronic devices (CIEDs) is sparse. We aimed to evaluate indications for implantation practice in the UK and quantify device utilisation. In this retrospective study, we included demographic, clinical and imaging data from patients in four of the largest UK Fabry centres. Ninety patients with Fabry disease were identified with CIEDs implanted between June 2001 and February 2018 (FD-CIED group). To investigate differences in clinical and imaging markers between those with and without devices, these patients were compared with 276 patients without a CIED (FD-control). In the FD-CIED group, 92% of patients with permanent pacemakers but only 28% with implantable cardioverter-defibrillators had a class 1 indication for implantation. A further 44% of patients had defibrillators inserted for primary prevention outside of current guidance. The burden of arrhythmia requiring treatment in the FD-CIED group was high (asymptomatic atrial fibrillation:29%; non-sustained ventricular tachycardia requiring medical therapy alone: 26%; sustained ventricular tachycardia needing anti-tachycardia pacing/defibrillation: 28%). Those with devices were older, had greater LV mass, more scar tissue and larger atrial size. Arrhythmias are common in Fabry patients. Those with cardiac devices had high rates of atrial fibrillation requiring anticoagulation and ventricular arrhythmia needing device treatment. These are as high as those in hypertrophic cardiomyopathy, supporting the need for Fabry-specific indications for device implantation. © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.

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