ESC TV Today – Your Cardiovascular News Season 3 - Ep.25: Arrhythmias in cardiac amyloidosis - Taking the 'O' out of HOCM: managing LVOT obstruction
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Oct 23, 2025 Stephanie Schwarting, a cardiac amyloidosis expert from University Hospital Munich, dives into arrhythmias in transthyretin cardiac amyloidosis, discussing management strategies and the nuances of treating atrial fibrillation in this context. Ahmad Masri, a cardiologist specializing in hypertrophic cardiomyopathy from Oregon Health & Science University, explores the complexities of managing LVOT obstruction and the role of myosin inhibitors versus traditional therapies. Both guests provide invaluable insights into cutting-edge treatments and patient management approaches.
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Different SCD Mechanisms By Amyloidosis Type
- Ventricular arrhythmia risk differs by amyloidosis subtype: AL patients have higher ventricular arrhythmia risk.
- In ATTR, sudden death more often follows pulseless electrical activity or conduction disease than ventricular tachyarrhythmia.
Disease Modification Lowers Arrhythmia Burden
- Disease‑modifying therapies can reduce arrhythmia burden alongside structural benefits.
- Tafamidis has been shown to reduce atrial fibrillation burden by about 30% in trials.
Assess Symptoms Deeply, Use Exercise Tests
- Explore reproducible exertional dyspnea, chest pain without coronary disease, and exertional syncope as key HCM symptoms.
- Use exercise testing because symptoms and LVOT gradients may not correlate with a single cutoff value like 50 mmHg.