Treatment of Cardiac Amyloidosis: Heart Failure and Progressive Conduction Disease

Cardiac amyloidosis involves progressive infiltration of the myocardium, with a natural history closely associated with both heart failure and electrical conduction disease. Standard heart failure therapies are often poorly tolerated in this setting. Symptomatic bradycardia and advanced atrioventricular block are recognised features as the disease advances.

Management addresses two distinct clinical problems: fluid overload driven by cardiac dysfunction, and the progressive deterioration of the conduction system. A diuretic approach forms the cornerstone of heart failure management, while device implantation is a key consideration — recommended at a lower clinical threshold than in other cardiac conditions, given how the disease evolves over time.

The full protocol — including specific indications, sequencing, and the criteria that guide device decisions — is available in the complete structured regimen.