What is the role of ECG in the workup of cardiac amyloidosis?

Updated: Mar 25, 2020
  • Author: Gyanendra K Sharma, MD, FACC, FASE; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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The following ECG abnormalities have been reported: [17, 45, 65]

  • Low voltage complexes (QRS amplitude ≤ 0.5 mV in limb leads or ≤ 1.0 mV in all precordial leads) are seen in 46% of cases (see image below).

    Low voltage complexes, atrial fibrillation. Low voltage complexes, atrial fibrillation.
  • Pseudo-infarct pattern is seen in 46% of cases (most common anteriorly).

  • Both low voltage complexes and pseudo-infarct pattern are seen in 25% of cases.

  • Left ventricular (LV) hypertrophy is unusual.

  • Atrial fibrillation and flutter are most common arrhythmias (20%).

  • Intraventricular conduction delay is seen.

  • High-degree atrioventricular (AV) block is unusual (3%).

  • Low-voltage complexes on ECG and increased mass on echocardiography are the best predictors of infiltrative cardiomyopathy.

Signal-averaged ECG

Late ECG potentials are seen in 31% patients with echocardiographic evidence of cardiac amyloidosis and are predictive of sudden cardiac death. [66]

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