Direct Current Cardioversion of Atrial Arrhythmias in Adults With Cardiac Amyloidosis

Edward A. El-Am, Angela Dispenzieri, Rowlens Melduni, Naser M. Ammash, Roger D. White, David O. Hodge, Peter Noseworthy, Grace D Lin, Sorin V. Pislaru, Alexander Egbe, Martha Grogan, Vuyisile T Nkomo

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Arrhythmias, conduction abnormalities, and intracardiac thrombus are common in patients with cardiac amyloidosis (CA). Outcomes of direct-current cardioversion (DCCV) for atrial arrhythmias in patients with CA are unknown. Objectives: This study sought to examine DCCV procedural outcomes in patients with CA. Methods: Patients with CA scheduled for DCCV for atrial arrhythmias from January 2000 through December 2012 were identified and matched 2:1 with control patients by age, sex, type of atrial arrhythmia, and date of DCCV. Results: CA patients (n = 58, mean age 69 ± 9 years, 81% male) were included. CA patients had a significantly higher cardioversion cancellation rate (28% vs. 7%; p < 0.001) compared with control patients, mainly due to intracardiac thrombus identified on transesophageal echocardiogram (13 of 16 [81%] vs. 2 of 8 [25%]; p = 0.02); 4 of 13 of the CA patients (31%) with intracardiac thrombus on transesophageal echocardiogram received adequate anticoagulation ≥3 weeks and another 2 of 13 (15%) had arrhythmia duration <48 h. DCCV success rate (90% vs. 94%; p = 0.4) was not different. Procedural complications were more frequent in CA versus control patients (6 of 42 [14%] vs. 2 of 106 [2%]; p = 0.007); complications in CA included ventricular arrhythmias in 2 and severe bradyarrhythmias requiring pacemaker implantation in 2. The only complication in the control group was self-limited bradyarrhythmias. Conclusions: Patients with CA undergoing DCCV had a significantly high cancellation rate mainly due to a high incidence of intracardiac thrombus even among patients who received adequate anticoagulation. Although the success rate of restoring sinus rhythm was high, tachyarrhythmias and bradyarrhythmias complicating DCCV were significantly more frequent in CA patients compared with control patients.

Original languageEnglish (US)
Pages (from-to)589-597
Number of pages9
JournalJournal of the American College of Cardiology
Volume73
Issue number5
DOIs
StatePublished - Feb 12 2019

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Electric Countershock
Amyloidosis
Cardiac Arrhythmias
Thrombosis
Bradycardia
Tachycardia

Keywords

  • atrial arrhythmia
  • atrial fibrillation
  • cardiac amyloidosis
  • cardioversion
  • intracardiac thrombus
  • transesophageal echocardiogram

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Direct Current Cardioversion of Atrial Arrhythmias in Adults With Cardiac Amyloidosis. / El-Am, Edward A.; Dispenzieri, Angela; Melduni, Rowlens; Ammash, Naser M.; White, Roger D.; Hodge, David O.; Noseworthy, Peter; Lin, Grace D; Pislaru, Sorin V.; Egbe, Alexander; Grogan, Martha; Nkomo, Vuyisile T.

In: Journal of the American College of Cardiology, Vol. 73, No. 5, 12.02.2019, p. 589-597.

Research output: Contribution to journalArticle

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title = "Direct Current Cardioversion of Atrial Arrhythmias in Adults With Cardiac Amyloidosis",
abstract = "Background: Arrhythmias, conduction abnormalities, and intracardiac thrombus are common in patients with cardiac amyloidosis (CA). Outcomes of direct-current cardioversion (DCCV) for atrial arrhythmias in patients with CA are unknown. Objectives: This study sought to examine DCCV procedural outcomes in patients with CA. Methods: Patients with CA scheduled for DCCV for atrial arrhythmias from January 2000 through December 2012 were identified and matched 2:1 with control patients by age, sex, type of atrial arrhythmia, and date of DCCV. Results: CA patients (n = 58, mean age 69 ± 9 years, 81{\%} male) were included. CA patients had a significantly higher cardioversion cancellation rate (28{\%} vs. 7{\%}; p < 0.001) compared with control patients, mainly due to intracardiac thrombus identified on transesophageal echocardiogram (13 of 16 [81{\%}] vs. 2 of 8 [25{\%}]; p = 0.02); 4 of 13 of the CA patients (31{\%}) with intracardiac thrombus on transesophageal echocardiogram received adequate anticoagulation ≥3 weeks and another 2 of 13 (15{\%}) had arrhythmia duration <48 h. DCCV success rate (90{\%} vs. 94{\%}; p = 0.4) was not different. Procedural complications were more frequent in CA versus control patients (6 of 42 [14{\%}] vs. 2 of 106 [2{\%}]; p = 0.007); complications in CA included ventricular arrhythmias in 2 and severe bradyarrhythmias requiring pacemaker implantation in 2. The only complication in the control group was self-limited bradyarrhythmias. Conclusions: Patients with CA undergoing DCCV had a significantly high cancellation rate mainly due to a high incidence of intracardiac thrombus even among patients who received adequate anticoagulation. Although the success rate of restoring sinus rhythm was high, tachyarrhythmias and bradyarrhythmias complicating DCCV were significantly more frequent in CA patients compared with control patients.",
keywords = "atrial arrhythmia, atrial fibrillation, cardiac amyloidosis, cardioversion, intracardiac thrombus, transesophageal echocardiogram",
author = "El-Am, {Edward A.} and Angela Dispenzieri and Rowlens Melduni and Ammash, {Naser M.} and White, {Roger D.} and Hodge, {David O.} and Peter Noseworthy and Lin, {Grace D} and Pislaru, {Sorin V.} and Alexander Egbe and Martha Grogan and Nkomo, {Vuyisile T}",
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T1 - Direct Current Cardioversion of Atrial Arrhythmias in Adults With Cardiac Amyloidosis

AU - El-Am, Edward A.

AU - Dispenzieri, Angela

AU - Melduni, Rowlens

AU - Ammash, Naser M.

AU - White, Roger D.

AU - Hodge, David O.

AU - Noseworthy, Peter

AU - Lin, Grace D

AU - Pislaru, Sorin V.

AU - Egbe, Alexander

AU - Grogan, Martha

AU - Nkomo, Vuyisile T

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N2 - Background: Arrhythmias, conduction abnormalities, and intracardiac thrombus are common in patients with cardiac amyloidosis (CA). Outcomes of direct-current cardioversion (DCCV) for atrial arrhythmias in patients with CA are unknown. Objectives: This study sought to examine DCCV procedural outcomes in patients with CA. Methods: Patients with CA scheduled for DCCV for atrial arrhythmias from January 2000 through December 2012 were identified and matched 2:1 with control patients by age, sex, type of atrial arrhythmia, and date of DCCV. Results: CA patients (n = 58, mean age 69 ± 9 years, 81% male) were included. CA patients had a significantly higher cardioversion cancellation rate (28% vs. 7%; p < 0.001) compared with control patients, mainly due to intracardiac thrombus identified on transesophageal echocardiogram (13 of 16 [81%] vs. 2 of 8 [25%]; p = 0.02); 4 of 13 of the CA patients (31%) with intracardiac thrombus on transesophageal echocardiogram received adequate anticoagulation ≥3 weeks and another 2 of 13 (15%) had arrhythmia duration <48 h. DCCV success rate (90% vs. 94%; p = 0.4) was not different. Procedural complications were more frequent in CA versus control patients (6 of 42 [14%] vs. 2 of 106 [2%]; p = 0.007); complications in CA included ventricular arrhythmias in 2 and severe bradyarrhythmias requiring pacemaker implantation in 2. The only complication in the control group was self-limited bradyarrhythmias. Conclusions: Patients with CA undergoing DCCV had a significantly high cancellation rate mainly due to a high incidence of intracardiac thrombus even among patients who received adequate anticoagulation. Although the success rate of restoring sinus rhythm was high, tachyarrhythmias and bradyarrhythmias complicating DCCV were significantly more frequent in CA patients compared with control patients.

AB - Background: Arrhythmias, conduction abnormalities, and intracardiac thrombus are common in patients with cardiac amyloidosis (CA). Outcomes of direct-current cardioversion (DCCV) for atrial arrhythmias in patients with CA are unknown. Objectives: This study sought to examine DCCV procedural outcomes in patients with CA. Methods: Patients with CA scheduled for DCCV for atrial arrhythmias from January 2000 through December 2012 were identified and matched 2:1 with control patients by age, sex, type of atrial arrhythmia, and date of DCCV. Results: CA patients (n = 58, mean age 69 ± 9 years, 81% male) were included. CA patients had a significantly higher cardioversion cancellation rate (28% vs. 7%; p < 0.001) compared with control patients, mainly due to intracardiac thrombus identified on transesophageal echocardiogram (13 of 16 [81%] vs. 2 of 8 [25%]; p = 0.02); 4 of 13 of the CA patients (31%) with intracardiac thrombus on transesophageal echocardiogram received adequate anticoagulation ≥3 weeks and another 2 of 13 (15%) had arrhythmia duration <48 h. DCCV success rate (90% vs. 94%; p = 0.4) was not different. Procedural complications were more frequent in CA versus control patients (6 of 42 [14%] vs. 2 of 106 [2%]; p = 0.007); complications in CA included ventricular arrhythmias in 2 and severe bradyarrhythmias requiring pacemaker implantation in 2. The only complication in the control group was self-limited bradyarrhythmias. Conclusions: Patients with CA undergoing DCCV had a significantly high cancellation rate mainly due to a high incidence of intracardiac thrombus even among patients who received adequate anticoagulation. Although the success rate of restoring sinus rhythm was high, tachyarrhythmias and bradyarrhythmias complicating DCCV were significantly more frequent in CA patients compared with control patients.

KW - atrial arrhythmia

KW - atrial fibrillation

KW - cardiac amyloidosis

KW - cardioversion

KW - intracardiac thrombus

KW - transesophageal echocardiogram

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