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Electrical cardioversion of atrial arrhythmias with cardiac amyloidosis in the era of direct oral anticogulants

AIMS: 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 LA...

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Autores principales: Touboul, Olivier, Algalarrondo, Vincent, Oghina, Silvia, Elbaz, Nathalie, Rouffiac, Segolene, Hamon, David, Extramiana, Fabrice, Gandjbakhch, Estelle, D'Humieres, Thomas, Marijon, Eloi, Dhanjal, Tarvinder S., Teiger, Emmanuel, Damy, Thibaud, Lellouche, Nicolas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9715864/
https://www.ncbi.nlm.nih.gov/pubmed/35903879
http://dx.doi.org/10.1002/ehf2.14082
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author Touboul, Olivier
Algalarrondo, Vincent
Oghina, Silvia
Elbaz, Nathalie
Rouffiac, Segolene
Hamon, David
Extramiana, Fabrice
Gandjbakhch, Estelle
D'Humieres, Thomas
Marijon, Eloi
Dhanjal, Tarvinder S.
Teiger, Emmanuel
Damy, Thibaud
Lellouche, Nicolas
author_facet Touboul, Olivier
Algalarrondo, Vincent
Oghina, Silvia
Elbaz, Nathalie
Rouffiac, Segolene
Hamon, David
Extramiana, Fabrice
Gandjbakhch, Estelle
D'Humieres, Thomas
Marijon, Eloi
Dhanjal, Tarvinder S.
Teiger, Emmanuel
Damy, Thibaud
Lellouche, Nicolas
author_sort Touboul, Olivier
collection PubMed
description AIMS: 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). METHODS AND RESULTS: 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. CONCLUSIONS: 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%).
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spelling pubmed-97158642022-12-05 Electrical cardioversion of atrial arrhythmias with cardiac amyloidosis in the era of direct oral anticogulants Touboul, Olivier Algalarrondo, Vincent Oghina, Silvia Elbaz, Nathalie Rouffiac, Segolene Hamon, David Extramiana, Fabrice Gandjbakhch, Estelle D'Humieres, Thomas Marijon, Eloi Dhanjal, Tarvinder S. Teiger, Emmanuel Damy, Thibaud Lellouche, Nicolas ESC Heart Fail Original Articles AIMS: 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). METHODS AND RESULTS: 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. CONCLUSIONS: 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%). John Wiley and Sons Inc. 2022-07-28 /pmc/articles/PMC9715864/ /pubmed/35903879 http://dx.doi.org/10.1002/ehf2.14082 Text en © 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles
Touboul, Olivier
Algalarrondo, Vincent
Oghina, Silvia
Elbaz, Nathalie
Rouffiac, Segolene
Hamon, David
Extramiana, Fabrice
Gandjbakhch, Estelle
D'Humieres, Thomas
Marijon, Eloi
Dhanjal, Tarvinder S.
Teiger, Emmanuel
Damy, Thibaud
Lellouche, Nicolas
Electrical cardioversion of atrial arrhythmias with cardiac amyloidosis in the era of direct oral anticogulants
title Electrical cardioversion of atrial arrhythmias with cardiac amyloidosis in the era of direct oral anticogulants
title_full Electrical cardioversion of atrial arrhythmias with cardiac amyloidosis in the era of direct oral anticogulants
title_fullStr Electrical cardioversion of atrial arrhythmias with cardiac amyloidosis in the era of direct oral anticogulants
title_full_unstemmed Electrical cardioversion of atrial arrhythmias with cardiac amyloidosis in the era of direct oral anticogulants
title_short Electrical cardioversion of atrial arrhythmias with cardiac amyloidosis in the era of direct oral anticogulants
title_sort electrical cardioversion of atrial arrhythmias with cardiac amyloidosis in the era of direct oral anticogulants
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9715864/
https://www.ncbi.nlm.nih.gov/pubmed/35903879
http://dx.doi.org/10.1002/ehf2.14082
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