A CASE OF AL AMYLOIDOSIS TREATED WITH PHYSIOLOGICAL PACING TO CONTROL ATRIAL BIGEMINY

A case of AL amyloidosis with sick sinus syndrome (SSS) is reported. The patient was a 68-year-old female, who had been treated with a VVI pacemaker for SSS from the age of 64. When she was 65years old, she suffered from palpitation which gradually subsided. Electrocardiograms during palpitation showed bigeminal cycles. Electrophysiological tests suggested that the bigeminy was a right ventricular pacing rhythm followed by supravetricular premature beats. They did not respond to any antiarr- hythmic drugs. Her laboratory data revealed anemia, elevated erythrocyte sedimentation rate, mild renal dysfunction and M-protein. Myocardial biopsy, renal biopsy and bone marrow aspiration were performed, and she was diagnosed as having AL amyloidosis. We employed a DDD pacemaker to control the atrial contractions, and she was relieved from the palpitations. Some considerations of pacemaker treatment with AL amyloidosis are described herein