循環器ジャーナル72巻3号

2024年07月発行

特集 心房細動—予防・早期発見・治療の進化 Ⅵ.特殊な病態

心アミロイドーシスに合併したAF治療戦略

著者： 金澤尚徳¹ 辻田賢一¹

所属機関： ¹熊本大学循環器内科

ページ範囲：P.468 - P.476

POINT
●近年，トランスサイレチン型心アミロイドーシス（ATTR-CM）と診断される症例が急増している．
●本疾患では病態の進行とともに心房細動，心房粗動，心房頻拍を合併することが多い．
●有症候性で心不全を来す不整脈であれば，アブレーションを検討してもよいと思われる．

参考文献

1）Connors LH, Sam F, Skinner M, et al. Heart Failure Resulting From Age-Related Cardiac Amyloid Disease Associated With Wild-Type Transthyretin : A Prospective, Observational Cohort Study. Circulation 2016 ; 133 : 282-90.

2）Kitaoka H, Izumi C, Izumiya Y, et al. JCS 2020 Guideline on Diagnosis and Treatment of Cardiac Amyloidosis. Circ J 2020 ; 84 : 1610-71.

3）Longhi S, Quarta CC, Milandri A, et al. Atrial fibrillation in amyloidotic cardiomyopathy : prevalence, incidence, risk factors and prognostic role. Amyloid 2015 ; 22 : 147-55.

4）Grogan M, Dispenzieri A. Natural history and therapy of AL cardiac amyloidosis. Heart Fail Rev 2015 ; 20 : 155-62.

5）Kanazawa H, Ito M, Kawahara Y, et al. Multiple focal atrial tachycardia as a characteristic finding of intractable arrhythmia associated with wild-type transthyretin amyloid cardiomyopathy. HeartRhythm Case Rep 2022 ; 8 : 420-4.

6）Kanazawa H, Takashio S, Hoshiyama T, et al. Clinical Outcomes of Catheter Ablation for Atrial Fibrillation, Atrial Flutter, and Atrial Tachycardia in Wild-Type Transthyretin Amyloid Cardiomyopathy : A Proposed Treatment Strategy for Catheter Ablation in Each Arrhythmia. Europace 2024 ; in press.

7）Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2017 ; 14 : e275-444.

8）Page RL, Joglar JA, Caldwell MA, et al. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia : A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2016 ; 133 : e506-74.

9）Nogami A, Kurita T, Abe H, et al. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021 ; 85 : 1104-244.

10）Forleo GB, De Martino G, Mantica M, et al. Clinical impact of catheter ablation in patients with asymptomatic atrial fibrillation : the IRON-AF（Italian registry on NavX atrial fibrillation ablation procedures）study. Int J Cardiol 2013 ; 168 : 3968-70.

11）Mohanty S, Santangeli P, Mohanty P, et al. Catheter ablation of asymptomatic longstanding persistent atrial fibrillation : impact on quality of life, exercise performance, arrhythmia perception, and arrhythmia-free survival. J Cardiovasc Electrophysiol 2014 ; 25 : 1057-64.

12）Yagishita A, Yamauchi Y, Sato H, et al. Improvement in the quality of life and exercise performance in relation to the plasma B-type natriuretic peptide level after catheter ablation in patients with asymptomatic persistent atrial fibrillation. Circ J 2017 ; 81 : 444-9.

13）Kanamori N, Kato T, Sakagami S, et al. Optimal lesion size index to prevent conduction gap during pulmonary vein isolation. J Cardiovasc Electrophysiol 2018 ; 29 : 1616-23.

14）Taghji P, El Haddad M, Phlips T, et al. Evaluation of a Strategy Aiming to Enclose the Pulmonary Veins With Contiguous and Optimized Radiofrequency Lesions in Paroxysmal Atrial Fibrillation : A Pilot Study. J Am Coll Cardiol EP 2018 ; 4 : 99-108.

15）Sanchis K, Cariou E, Colombat M, et at. Atrial fibrillation and subtype of atrial fibrillation in cardiac amyloidosis : clinical and echocardiographic features, impact on mortality. Amyloid 2019 ; 26 : 128-38.

16）Mints YY, Doros G, Berk JL, et al. Features of atrial fibrillation in wild-type transthyretin cardiac amyloidosis : a systematic review and clinical experience. ESC Heart Fail 2018 ; 5 : 772-9.

17）Black-Maier E, Rehorn M, Loungani R, et al. Catheter ablation of atrial fibrillation in cardiac amyloidosis. Pacing Clin Electrophysiol 2020 ; 43 : 913-21.

18）Donnellan E, Wazni O, Kanj M, et al. Atrial fibrillation ablation in patients with transthyretin cardiac amyloidosis. Europace 2020 ; 22 : 259-64.

19）Barbhaiya CR, Kumar S, Baldinger SH, et al. Electrophysiologic assessment of conduction abnormalities and atrial arrhythmias associated with amyloid cardiomyopathy. Heart Rhythm 2016 ; 13 : 383-90.

20）Tan NY, Mohsin Y, Hodge DO, et al. Catheter Ablation for Atrial Arrhythmias in Patients With Cardiac Amyloidosis. J Cardiovasc Electrophysiol 2016 ; 27 : 1167-73.

21）González-López E, Gagliardi C, Dominguez F, et al. Clinical characteristics of wild-type transthyretin cardiac amyloidosis : disproving myths. Eur Heart J 2017 ; 38 : 1895-904.