Author + information
- Received May 1, 2019
- Revision received July 31, 2019
- Accepted August 18, 2019
- Published online October 28, 2019.
- Sharan Prakash Sharma, MDa,
- Mohit K. Turagam, MDb,
- Rakesh Gopinathannair, MDa,
- Vivek Reddy, MDb,
- Saibal Kar, MDc,
- Sangamitra Mohanty, MDd,
- Jie Cheng, MDe,
- David R. Holmes Jr., MDf,
- Lars Sondergaard, MDg,
- Andrea Natale, MDd and
- Dhanunjaya Lakkireddy, MDa,∗ (, )@DJ_Lakkireddy
- aKansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas
- bIcahn School of Medicine at Mount Sinai, New York, New York
- cCedars-Sinai Medical Center, Los Angeles, California
- dTexas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
- eTexas Heart Institute, St. Luke's Hospital, Houston, Texas
- fDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- gThe Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- ↵∗Address for correspondence:
Dr. Dhanunjaya Lakkireddy, University of Missouri Columbia, The Kansas City Heart Rhythm Institute (KCHRI) @ HCA MidWest, 12200, West 106th Street, Overland Park Regional Medical Center, Overland Park, Kansas 66215.
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.
Dr. Gopinathannair has received a research grant from Boston Scientific; and has served as a consultant to St. Jude Medical, Pfizer, and Zoll Medical. Dr. Reddy has served as a consultant to Boston Scientific, Abbott, and Biosense Webster. Dr. Kar has served as a consultant to Boston Scientific, Abbott Vascular, and WL Gore. Dr. Andrea has served as a consultant to Biosense Webster and Abbott. Dr. Cheng has served as a consultant to LifeTech. Dr. Sondergaard has served as a consultant to Boston Scientific. Dr. Natale has served as a consultant to and on the Speakers Bureau of Biotronik, Medtronic, Biosense Webster, St. Jude, and Abbott. Dr. Lakkireddy has served as a consultant to Boston Scientific, Biotronik, Medtronic, and Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Deepak L. Bhatt, MD, MPH, served as Guest Editor-in-Chief for this paper.
- Received May 1, 2019.
- Revision received July 31, 2019.
- Accepted August 18, 2019.
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