Management Strategies for Atrial Fibrillation and Flutter in Patients with Transthyretin Cardiac Amyloidosis

被引:14
|
作者
Dale, Zack [1 ]
Chandrashekar, Pranav [1 ]
Al-Rashdan, Lana [1 ]
Kim, Morris [1 ]
Masri, Ahmad [1 ]
Nazer, Babak [1 ]
机构
[1] Oregon Hlth & Sci Univ, Knight Cardiovasc Inst, Ctr Amyloidosis, Portland, OR 97201 USA
来源
关键词
CATHETER ABLATION; INTRACARDIAC THROMBOSIS; CARDIOMYOPATHY; ARRHYTHMIAS;
D O I
10.1016/j.amjcard.2021.07.028
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Atrial fibrillation (AF) and flutter (AFL) frequently complicate transthyretin cardiac amyloidosis (ATTR-CM). Management poses challenges as rate control drugs are poorly tolerated and data addressing tolerability and efficacy of rhythm control is limited. We report outcomes of AF/AFL in ATTR-CM in a single center observational study of patients seen at our Amyloidosis Center with wild-type or hereditary ATTR-CM diagnosed between 2005-2019 including 84 patients (average age 74 +/- 10 years, 94% male) with 27.6 +/- 22.8 months follow-up. AF/AFL occurred in 61 patients (73%). Rapid ventricular response was common as was attempted rate control. However, discontinuation of rate control drugs was frequent (80%), often for adverse effects. Rhythm control was attempted in 64%, usually with cardioversion (DCCV) or ablation. Post-DCCV recurrence was common (91%) and time to recurrence was similar with or without anti-arrhythmic drugs (5.8 months (IQR 1.9-12.5) vs 6.2 months (IQR 1.9-12.5) p = 0.83). Ablation was performed in 23% with AFL (all for typical AFL) with 14% recurrence after mean of 60.9 months. Ablation for AF was performed in 12% with 86% recurrence after median of 6.2 months (IQR 5.6-12.3). Most patients (62%) with rhythm control had subjective improvement (>= 1 NYHA class or resolved palpitations). In conclusion, AF/AFL was common in our cohort. Rate control was poorly tolerated and often abandoned. Rhythm control led to symptomatic improvement in a majority of cases, but durable success was limited. DCCV was modestly successful and not significantly improved with anti-arrhythmics. Ablation was successful with typical AFL but had limited success in AF. (C) 2021 Elsevier Inc. All rights reserved.
引用
收藏
页码:107 / 114
页数:8
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