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Published on: February 26, 2013
Direct Current Cardioversion of Atrial Fibrillation in Patients With Left Atrial Appendage Occlusion Devices
Sharan Prakash Sharma1, Mohit K Turagam2, Rakesh Gopinathannair1
1Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas.
Insights
Direct current cardioversion (DCCV) is safe for patients with left atrial appendage occlusion (LAAO) devices, with no thromboembolic complications observed. This procedure effectively restores sinus rhythm, offering a viable rhythm control strategy.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Direct current cardioversion (DCCV) is a standard treatment for symptomatic atrial fibrillation/flutter.
- Long-term safety data for DCCV in patients with left atrial appendage occlusion (LAAO) devices is lacking.
Purpose of the Study:
- To evaluate the feasibility and safety of performing DCCV in patients who have undergone LAAO device implantation.
Main Methods:
- A multicenter retrospective study involving 148 patients with LAAO devices who underwent DCCV.
- Pre-procedural transesophageal echocardiograms were performed on all patients.
- Patients with device-related thrombus were treated with oral anticoagulation before DCCV.
Main Results:
- DCCV successfully restored sinus rhythm in all patients.
- No DCCV-related thromboembolic complications occurred.
- Follow-up showed no device thrombosis, dislodgement, or leaks.
Conclusions:
- DCCV is feasible in high-risk atrial fibrillation patients with LAAO devices.
- Transesophageal echocardiography is crucial for assessing device position and absence of thrombus/leak.
- Further research is needed to confirm the long-term safety of DCCV with LAAO devices.
Background:
Direct current cardioversion (DCCV) is a common rhythm control strategy in patients with symptomatic atrial fibrillation or flutter. There is no long-term data regarding the safety of DCCV in patients with endocardial left atrial appendage occlusion (LAAO) devices.
Objectives:
The purpose of this study was to assess the feasibility and safety of DCCV in patients with an LAAO device.
Methods:
This multicenter retrospective study included 148 patients with an LAAO device who underwent DCCV for symptomatic atrial fibrillation or atrial flutter.
Results:
The average age of the included patients was 72 ± 7 years and 59% were men. All patients (100%) had a transesophageal echocardiogram prior to DCCV. Device-related thrombus was seen in 2.7%. They were all successfully treated with oral anticoagulation (OAC) and were able to undergo DCCV after 6 to 8 weeks. DCCV restored sinus rhythm in all patients. None of the patients had DCCV-related thromboembolic complications. A total of 22% of patients were newly started on OAC after DCCV. There was no difference in DCCV-related complications between patients treated with or without OAC post-DCCV. Patients receiving OAC post-DCCV were found to undergo cardioversion at an earlier time after implantation (3.6 months [interquartile range (IQR): 0.7 to 8.6 months] vs. 8.6 months [IQR: 2.5 to 13.3 months]; p = 0.003). Three transient ischemic attacks, unrelated to DCCV, were found during follow-up. During a median follow-up of 12.8 months (IQR: 11.8 to 14.2 months), no device or left atrial thrombosis, device dislodgement, or a new device leak were observed. One patient died during follow-up due to noncardiac cause.
Conclusions:
DCCV is feasible in high-risk AF patients with an LAAO device without the need for oral anticoagulation if pre-procedural transesophageal echocardiography shows good device position, absence of device-related thrombus, and peridevice leak of ≤5 mm. The preliminary results are encouraging, but further large studies are warranted to establish safety.
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