Systemic AL Amyloid and Recurrent Tachycardia

This 56-year-old woman with systemic AL amyloid and biopsy-proven cardiac involvement developed recurrent atrial arrhythmias during the course of her chemotherapy and autologous stem-cell transplant. Anticoagulation and amiodarone were commenced and external cardioversion was performed for restoration of sinus rhythm, but arrhythmia recurrence with rapid ventricular rates ensued. She was referred for further evaluation because of marked exercise intolerance.

Figure 1: Systemic AL Amyloid and Recurrent Tachycardia
Baseline 12-lead ECG is shown in figure 1. On echocardiography, her left atrial dimension was 4.0 cm in diameter and LV ejection fraction was 50% with Doppler trans-mitral flow evidence for diastolic function.

For this patient, you would recommend treatment with:

Show Answer