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Patients with transthyretin amyloidosis cardiomyopathy (ATTR-CM) are at risk of cardiovascular comorbidities, including atrial fibrillation and flutter. Routine ambulatory monitoring in patients with ATTR-CM could help drive the use of anticoagulation to prevent strokes.

Heart complications, such as heart failure, are common in patients with transthyretin amyloidosis cardiomyopathy (ATTR-CM). Atrial fibrillation and flutter (AF/AFL), in particular, is a common cardiovascular comorbidity associated with ATTR-CM. However, atrial fibrillation and flutter may be overlooked in patients with ATTR-CM without a proper diagnosis. As a result, patients with ATTR-CM and AF/AFL may be at an increased risk of stroke, which needs appropriate anticoagulant treatment.

One study, published in the International Journal of Cardiology, evaluated the prevalence of AF/AFL and outcomes of routine ambulatory monitoring in patients with ATTR-CM. Healthcare providers implemented routine ambulatory ECG monitoring every six months in patients without known AF/AFL at baseline. Researchers retrieved data from an amyloidosis center of patients with wild-type or variant ATTR-CM.

Of 84 patients with ATTR-CM, 40 patients (48%) had AF/AFL before a diagnosis of ATTR-CM. Around 20 patients were diagnosed with AF/AFL after an ATTR-CM diagnosis, with 10 diagnosed based on symptoms and 11 diagnosed based on monitoring. Anticoagulation was started in 82% of patients with incidental AF/AFL. In patients receiving anticoagulation, no strokes were reported.

Due to the high prevalence of atrial fibrillation and flutter in patients with ATTR-CM, routine monitoring is a valuable aspect of care to ensure patients get preventive stroke treatment, as needed. Overlooking AF/AFL in patients with ATTR-CM could have serious consequences, as patients with ATTR-CM already face heart complications and an increased risk of hospitalization and mortality. While tafamidis is an approved medication to reduce hospitalization and mortality from ATTR-CM, anticoagulants can help reduce the risk of stroke in patients with ATTR-CM and atrial fibrillation and flutter.

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Dale, Z., Chandrashekar, P., Al-Rashdan, L., Gill, S., Elman, M., Fischer, K. L., Nazer, B., & Masri, A. (2022). Routine ambulatory heart rhythm monitoring for detection of atrial arrhythmias in transthyretin cardiac amyloidosis. International Journal of Cardiology, 358, 65-71. https://doi.org/10.1016/j.ijcard.2022.04.045

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