Journal article
Electrical cardioversion of atrial arrhythmias with cardiac amyloidosis in the era of direct oral anticogulants
ESC Heart Failure, Vol.9(5), pp.3556-3564
10/2022
DOI: 10.1002/ehf2.14082
PMCID: PMC9715864
PMID: 35903879
Abstract
Atrial fibrillation (AF)/atrial flutter is common during cardiac amyloidosis (CA). Electrical cardioversion (EC) is a strategy to restore sinus rhythm (SR). However, left atrial thrombus (LAT) represents a contraindication for EC. CA patients with AF/atrial flutter have a high prevalence of LAT. We aimed to evaluate EC characteristics, LAT prevalence and risk factors, and AF/atrial flutter outcome in CA patients undergoing EC, predominantly treated with direct oral anticoagulants (DOACs).
All patients with CA and AF/atrial flutter referred for the first time to our national referral centre of amyloidosis for EC from June 2017 to February 2021 were included in this study. In total, 66 patients (median age 74.5 [70;80.75] years, 67% male) were included with anticoagulation consisted of DOAC in 74% of cases. All patients underwent cardiac imaging before EC to rule out LAT. EC was cancelled due to LAT in 14% of cases. Complete thrombus resolution was observed in only 17% of cases. The two independent parameters associated with LAT were creatinine [hazard ratio (HR) = 1.01; confidence interval (CI) = 1.00-1.03, P = 0.036] and the use of antiplatelet agents (HR = 13.47; CI = 1.85-98.02). EC acute success rate was 88%, and we observed no complication after EC. With 64% of patients under amiodarone, AF/atrial flutter recurrence rate following EC was 51% after a mean follow-up of 30 ± 27 months.
Left atrial thrombus was observed in 14% of CA patients listed for EC and mainly treated with DOAC. The acute EC success rate was high with no complication. The long-term EC success rate was acceptable (49%).
Details
- Title: Subtitle
- Electrical cardioversion of atrial arrhythmias with cardiac amyloidosis in the era of direct oral anticogulants
- Creators
- Olivier Touboul - Department of Cardiology, AP-HP, University Hospital Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, 94000, Creteil, FranceVincent Algalarrondo - Department of Cardiology, AP-HP, University Hospital Bichat, Paris, FranceSilvia Oghina - Department of Cardiology, AP-HP, University Hospital Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, 94000, Creteil, FranceNathalie Elbaz - Department of Cardiology, AP-HP, University Hospital Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, 94000, Creteil, FranceSegolene Rouffiac - Department of Cardiology, AP-HP, University Hospital Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, 94000, Creteil, FranceDavid Hamon - Department of Cardiology, AP-HP, University Hospital Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, 94000, Creteil, FranceFabrice Extramiana - Unité de recherche sur les maladies cardiovasculaires et métaboliquesEstelle Gandjbakhch - Department of Cardiology, AP-HP, University Hospital Pitié-Salpétrière, Paris, FranceThomas D'Humieres - Department of Physiology, AP-HP, University Hospital Henri Mondor, Creteil, FranceEloi Marijon - Hôpital Européen Georges-PompidouTarvinder S Dhanjal - University of WarwickEmmanuel Teiger - Department of Cardiology, AP-HP, University Hospital Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, 94000, Creteil, FranceThibaud Damy - Department of Cardiology, AP-HP, University Hospital Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, 94000, Creteil, FranceNicolas Lellouche - Department of Cardiology, AP-HP, University Hospital Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, 94000, Creteil, France
- Resource Type
- Journal article
- Publication Details
- ESC Heart Failure, Vol.9(5), pp.3556-3564
- DOI
- 10.1002/ehf2.14082
- PMID
- 35903879
- PMCID
- PMC9715864
- ISSN
- 2055-5822
- eISSN
- 2055-5822
- Language
- English
- Date published
- 10/2022
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984694745802771
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