Cardiac amyloidosis (CA) is an increasingly recognized cause of heart failure, characterized by extracellular deposition of insoluble protein fibrils leading to progressive myocardial dysfunction. The most common types of cardiac amyloidosis are immunoglobin light-chain (AL) and transthyretin (ATTR). Conduction abnormalities are commonly encountered among patients with cardiac amyloidosis and are an important cause of morbidity and mortality. Abnormalities range from infra-Hisian intraventricular conduction delay and bundle branch block to complete atrioventricular block. Pacemaker placement in CA patients follows established guidelines, similar to those for patients without CA, with generally good efficacy. The role and appropriate timing of pacemakers for primary prevention of brady-arrhythmias in CA remains uncertain. While biventricular (BiV) pacing has been shown to improve clinical outcomes in patients with systolic heart failure without CA, there are few data examining the utility of BiV pacing in patients with CA. With the advent of effective treatments for AL and ATTR, appropriate application of pacing is important to support patients with CA and conduction disease through therapeutic trials. This systematic review summarizes the current literature examining the utility of pacing in CA.

中文翻译：

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传导异常和心脏起搏在心脏淀粉样变性中的作用：系统评价

心脏淀粉样变性 (CA) 是一种越来越被认可的心力衰竭原因，其特征是不溶性蛋白原纤维的细胞外沉积，导致进行性心肌功能障碍。最常见的心脏淀粉样变性类型是免疫球蛋白轻链 (AL) 和转甲状腺素蛋白 (ATTR)。传导异常在心脏淀粉样变性患者中很常见，是导致发病率和死亡率的重要原因。异常范围从 infra-Hisian 室内传导延迟和束支传导阻滞到完全性房室传导阻滞。在 CA 患者中放置起搏器遵循既定指南，类似于没有 CA 的患者，通常具有良好的疗效。心脏起搏器在 CA 患者缓慢性心律失常一级预防中的作用和适当时机仍不确定。虽然双心室 (BiV) 起搏已被证明可以改善无 CA 的收缩性心力衰竭患者的临床结果，但很少有数据检验 BiV 起搏在 CA 患者中的效用。随着 AL 和 ATTR 的有效治疗方法的出现，适当应用起搏对于通过治疗试验支持 CA 和传导疾病患者很重要。本系统综述总结了当前研究起搏在 CA 中的效用的文献。