Ventricular tachyarrhythmias and sudden cardiac death in light-chain amyloidosis: a clash of cardio-toxicities?

Sudden cardiac death (SCD) is not uncommon in immunoglobulin light-chain amyloidosis (AL) and has been usually attributed to pulseless electrical activity (PEA) or agonal bradycardia occurring in the late stages of the cardiomyopathy.1, 2 In addition, the historically reported survival of <12 months in patients with cardiac AL has represented a contraindication to an implantable cardioverter defibrillator (ICD).3 Reports based on small series have further discouraged use of an ICD in this disease.4, 5 However, recently, the evolution of treatment options has improved overall survival,6 opening new perspectives in terms of cardiac protection, and calling for further understanding of the arrhythmic profile and SCD prevention in patients with AL.