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Direct Current Cardioversion of Atrial Arrhythmias in Adults With Cardiac Amyloidosis

Edward A El-Am1, Angela Dispenzieri2, Rowlens M Melduni3

  • 1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: https://twitter.com/EdwardElAmm.

Journal of the American College of Cardiology
|February 9, 2019
PubMed

Insights

Direct-current cardioversion (DCCV) for atrial arrhythmias in cardiac amyloidosis (CA) patients has a high cancellation rate due to intracardiac thrombus. While DCCV success is high, complications like tachyarrhythmias and bradyarrhythmias are more frequent in CA patients.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Amyloidosis Research

Background:

  • Cardiac amyloidosis (CA) frequently presents with arrhythmias, conduction abnormalities, and intracardiac thrombus.
  • The efficacy and safety of direct-current cardioversion (DCCV) for atrial arrhythmias in CA patients remain largely uncharacterized.

Purpose of the Study:

  • To investigate the procedural outcomes of direct-current cardioversion (DCCV) in patients diagnosed with cardiac amyloidosis (CA).

Main Methods:

  • A retrospective analysis matched 58 CA patients undergoing DCCV for atrial arrhythmias with 116 control patients (2:1 ratio) from 2000-2012.
  • Matching criteria included age, sex, arrhythmia type, and DCCV date.
  • Transesophageal echocardiography was used to assess for intracardiac thrombus.

Main Results:

  • CA patients exhibited a significantly higher DCCV cancellation rate (28% vs. 7%) primarily due to intracardiac thrombus (81% in CA vs. 25% in controls).
  • Despite adequate anticoagulation in some CA patients with thrombus, DCCV was still frequently cancelled.
  • DCCV success rates were similar (90% vs. 94%), but procedural complications were more frequent in CA patients (14% vs. 2%), including ventricular arrhythmias and severe bradyarrhythmias requiring pacemaker implantation.

Conclusions:

  • Cardiac amyloidosis patients undergoing DCCV face a high cancellation rate due to intracardiac thrombus, even with anticoagulation.
  • While restoring sinus rhythm is successful, DCCV is associated with increased tachyarrhythmia and bradyarrhythmia complications in CA patients compared to controls.
Abstract

Keywords:
atrial arrhythmiaatrial fibrillationcardiac amyloidosiscardioversionintracardiac thrombustransesophageal echocardiogram

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