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The Capital Region of Denmark - a part of Copenhagen University Hospital
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Direct Current Cardioversion of Atrial Fibrillation in Patients With Left Atrial Appendage Occlusion Devices

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  • Sharan Prakash Sharma
  • Mohit K Turagam
  • Rakesh Gopinathannair
  • Vivek Reddy
  • Saibal Kar
  • Sangamitra Mohanty
  • Jie Cheng
  • David R Holmes
  • Lars Sondergaard
  • Andrea Natale
  • Dhanunjaya Lakkireddy
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BACKGROUND: Direct current cardioversion (DCCV) is a common rhythm control strategy in patients with symptomatic atrial fibrillation or flutter. There is no long-term data regarding the safety of DCCV in patients with endocardial left atrial appendage occlusion (LAAO) devices.

OBJECTIVES: The purpose of this study was to assess the feasibility and safety of DCCV in patients with an LAAO device.

METHODS: This multicenter retrospective study included 148 patients with an LAAO device who underwent DCCV for symptomatic atrial fibrillation or atrial flutter.

RESULTS: The average age of the included patients was 72 ± 7 years and 59% were men. All patients (100%) had a transesophageal echocardiogram prior to DCCV. Device-related thrombus was seen in 2.7%. They were all successfully treated with oral anticoagulation (OAC) and were able to undergo DCCV after 6 to 8 weeks. DCCV restored sinus rhythm in all patients. None of the patients had DCCV-related thromboembolic complications. A total of 22% of patients were newly started on OAC after DCCV. There was no difference in DCCV-related complications between patients treated with or without OAC post-DCCV. Patients receiving OAC post-DCCV were found to undergo cardioversion at an earlier time after implantation (3.6 months [interquartile range (IQR): 0.7 to 8.6 months] vs. 8.6 months [IQR: 2.5 to 13.3 months]; p = 0.003). Three transient ischemic attacks, unrelated to DCCV, were found during follow-up. During a median follow-up of 12.8 months (IQR: 11.8 to 14.2 months), no device or left atrial thrombosis, device dislodgement, or a new device leak were observed. One patient died during follow-up due to noncardiac cause.

CONCLUSIONS: DCCV is feasible in high-risk AF patients with an LAAO device without the need for oral anticoagulation if pre-procedural transesophageal echocardiography shows good device position, absence of device-related thrombus, and peridevice leak of ≤5 mm. The preliminary results are encouraging, but further large studies are warranted to establish safety.

Original languageEnglish
JournalJournal of the American College of Cardiology
Volume74
Issue number18
Pages (from-to)2267-2274
Number of pages8
ISSN0735-1097
DOIs
Publication statusPublished - 5 Nov 2019

ID: 59144123