“There's something wrong here, there's no denying. One of us is changing, or maybe we just stopped trying.” While singing about love, Carole King clearly summarized the challenge of arrhythmia management in cardiac amyloidosis: because effective treatments for these arrhythmias are lacking, early identification of amyloidosis and early intervention are necessary to prevent adverse outcomes and mortality.

Cardiac amyloidosis diagnosis is challenging because patients are often minimally symptomatic during the early stages of amyloid infiltration and may present with vague symptoms like dyspnea, fatigue, and edema, which are often mislabeled as nonamyloid heart failure with preserved ejection fraction (HFpEF) [1]. By the time cardiac infiltration has advanced enough to produce overt electrical and structural abnormalities, opportunities for intervention may be limited. Unfortunately, misdiagnosis and delayed diagnosis are common in cardiac amyloidosis, which may result in increased symptom burden, cumulative organ damage, and increased mortality. A prior study showed that cardiac amyloidosis diagnosis delays greater than six months after symptom onset correlate with poorer survival, while early diagnosis within six months of symptoms onset is associated with better outcomes [2].