May 19, 2026Journal of the American College of Cardiology
Direct Current Cardioversion of Atrial Arrhythmias in Adults With Cardiac Amyloidosis
Key result
DC cardioversion in cardiac amyloidosis is linked to a ~28% cancellation rate and more procedural complications.
- P<0.001
- n=174
Why the study?
Arrhythmias, conduction abnormalities, and intracardiac thrombus are common in cardiac amyloidosis, but outcomes of direct-current cardioversion for atrial arrhythmias in these patients are unknown.
Does direct-current cardioversion for atrial arrhythmias have different procedural outcomes and complication rates in patients with cardiac amyloidosis compared to matched controls?
Population
58 patients with cardiac amyloidosis scheduled for DCCV for atrial arrhythmias and matched controls
Comparison
Cardiac amyloidosis patients vs 2:1 matched control patients
Design
Matched cohort study
Authors
Discussion
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Implication
Supports caution with DCCV in cardiac amyloidosis; hypothesis-generating and requires prospective validation.
Key Points
- This study examines the procedural outcomes of direct-current cardioversion (DCCV) in patients with cardiac amyloidosis (CA).
- Patients with cardiac amyloidosis scheduled for DCCV from January 2000 to December 2012 were matched 2:1 to controls based on age, sex, and type of arrhythmia.
- A total of 58 CA patients and their matched controls were included for comparison of cardioversion rates, complications, and thrombus rates.
- CA patients had a higher cancellation rate of 28% compared to 7% in controls (p < 0.001), primarily due to thrombus identified.
- Success rate for DCCV was generally high at 90%, but complications occurred more frequently in CA patients (14% vs. 2% in controls, p = 0.007).
- Complications in CA included serious issues like ventricular arrhythmias in 2 patients and severe bradyarrhythmias requiring pacemaker in another 2.
Study Design
Type
Cohort (n=174)
Structured PICO
Does direct-current cardioversion for atrial arrhythmias have different procedural outcomes and complication rates in patients with cardiac amyloidosis compared to matched controls?
P
Population
174 adults (58 with cardiac amyloidosis, 116 matched controls) scheduled for direct-current cardioversion for atrial arrhythmias. CA group: mean age 69 ± 9 years, 81% male.
I
Intervention
Direct-current cardioversion (DCCV) for atrial arrhythmias
C
Comparator
Matched control patients without cardiac amyloidosis (matched 2:1 by age, sex, type of atrial arrhythmia, and date of DCCV)
O
Outcome
DCCV procedural outcomes including cancellation rate, success rate, and procedural complications
Main Result
Absolute Event Rate: 28% vs 7%
p-value: p=<0.001
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.
Cite This Study
El‐Am et al. (2019) 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.