Direct Current Cardioversion of Atrial Arrhythmias in Adults With Cardiac Amyloidosis
Direct Current Cardioversion of Atrial Arrhythmias in Adults With Cardiac Amyloidosis
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DOI：
10.1016/j.jacc.2018.10.079
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发表时间：
2019-02-12
影响因子：
24
通讯作者：
Nkomo, Vuyisile T.
中科院分区：
文献类型：
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作者：
El-Am, Edward A.;Dispenzieri, Angela;Nkomo, Vuyisile T.
心律失常、传导异常和心内血栓在心脏淀粉样变性（CA）患者中常见。直流电复律（DCCV）治疗CA患者房性心律失常的结果尚不清楚。结论本研究旨在检查CA患者DCCV手术结果。方法从2000年1月至2012年12月，确定并匹配2：结果CA患者（n = 58，平均年龄69 ± 9岁，81%为男性）纳入研究。CA患者的心脏复律取消率显著较高，（28% vs. 7%; p < 0.001）与对照组患者相比，主要是由于经食管超声心动图发现的心内血栓（13/16 [81%] vs. 2/8 [25%]; p = 0.02）; 13例经食管超声心动图显示心内血栓的CA患者中有4例（31%）接受了足够的抗凝治疗>=心律失常持续时间< 48 h者2例（15%）。DCCV成功率（90% vs. 94%; p = 0.4）无差异。CA患者的手术并发症发生率高于对照组患者（6/42 [14%] vs. 2/106 [2%]; p = 0.007）; CA患者的并发症包括2例室性心律失常和2例需要植入起搏器的重度缓慢性心律失常。在对照组中唯一的并发症是自限性缓慢性心律失常。结论CA患者接受DCCV有显着高的取消率，主要是由于高发病率的心内血栓，即使在患者谁得到足够的抗凝。虽然恢复窦性心律的成功率很高，但与对照组患者相比，CA患者并发DCCV的快速性心律失常和缓慢性心律失常明显更常见。(c)2019年由美国心脏病学会基金会。
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. (c) 2019 by the American College of Cardiology Foundation.