Author + information
- Received July 21, 2018
- Revision received October 18, 2018
- Accepted October 22, 2018
- Published online February 4, 2019.
- Edward A. El-Am, MDa@EdwardElAmm,
- Angela Dispenzieri, MDb,
- Rowlens M. Melduni, MD, MPHa,
- Naser M. Ammash, MDa,
- Roger D. White, MDc,
- David O. Hodge, MSd,
- Peter A. Noseworthy, MDa,
- Grace Lin, MDa,
- Sorin V. Pislaru, MD, PhDa,
- Alexander C. Egbe, MBBS, MPHa,
- Martha Grogan, MDa@MarthaGrogan1 and
- Vuyisile T. Nkomo, MD, MPHa,∗ ()
- aDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- bDivision of Hematology, Mayo Clinic, Rochester, Minnesota
- cDepartment of Anesthesiology, Mayo Clinic, Rochester, Minnesota
- dBiomedical Science and Informatics, Mayo Clinic, Jacksonville, Florida
- ↵∗Address for correspondence:
Dr. Vuyisile T. Nkomo, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
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.
- atrial arrhythmia
- atrial fibrillation
- cardiac amyloidosis
- intracardiac thrombus
- transesophageal echocardiogram
This work was funded by the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received July 21, 2018.
- Revision received October 18, 2018.
- Accepted October 22, 2018.
- 2019 American College of Cardiology Foundation
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