Direct-current cardioversion in patients with cardiac amyloidosis had a higher cancellation rate (28% vs. 7%; p<0.001) and more procedural complications (14% vs. 2%; p=0.007) than matched controls.
Cohort (n=174)
Does direct-current cardioversion for atrial arrhythmias have different procedural outcomes and complication rates in patients with cardiac amyloidosis compared to matched controls?
Patients with cardiac amyloidosis undergoing DCCV have a high risk of cancellation due to intracardiac thrombus (even with adequate anticoagulation) and higher rates of procedural complications like bradyarrhythmias and ventricular arrhythmias.
Absolute Event Rate: 28% vs 7%
p-value: p=<0.001
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. (J Am Coll Cardiol 2019;73:589–97)
El‐Am et al. (Fri,) conducted a cohort in Cardiac amyloidosis and atrial arrhythmias (n=174). Direct-current cardioversion vs. Matched control patients was evaluated on Cardioversion cancellation rate (p=<0.001). Direct-current cardioversion in patients with cardiac amyloidosis had a higher cancellation rate (28% vs. 7%; p<0.001) and more procedural complications (14% vs. 2%; p=0.007) than matched controls.