Catheter ablation of atrial fibrillation in cardiac amyloidosis.

Autor: Black-Maier E; Division of Electrophysiology, Duke University Medical Center, Durham, North Carolina., Rehorn M; Division of Electrophysiology, Duke University Medical Center, Durham, North Carolina., Loungani R; Division of Cardiology, Duke University Medical Center, Durham, North Carolina., Friedman DJ; Section of Cardiac Electrophysiology, Yale School of Medicine, New Haven, Connecticut., Alenezi F; Division of Cardiology, Duke University Medical Center, Durham, North Carolina., Geurink K; Department of Medicine, Duke University Medical Center, Durham, North Carolina., Pokorney SD; Division of Electrophysiology, Duke University Medical Center, Durham, North Carolina., Daubert JP; Division of Electrophysiology, Duke University Medical Center, Durham, North Carolina., Sun AY; Division of Electrophysiology, Duke University Medical Center, Durham, North Carolina., Atwater BD; Division of Electrophysiology, Duke University Medical Center, Durham, North Carolina., Jackson KP; Division of Electrophysiology, Duke University Medical Center, Durham, North Carolina., Hegland DD; Division of Electrophysiology, Duke University Medical Center, Durham, North Carolina., Thomas KL; Division of Electrophysiology, Duke University Medical Center, Durham, North Carolina., Bahnson TD; Division of Electrophysiology, Duke University Medical Center, Durham, North Carolina., Khouri MG; Division of Cardiology, Duke University Medical Center, Durham, North Carolina., Piccini JP; Division of Electrophysiology, Duke University Medical Center, Durham, North Carolina.
Jazyk: angličtina
Zdroj: Pacing and clinical electrophysiology : PACE [Pacing Clin Electrophysiol] 2020 Sep; Vol. 43 (9), pp. 913-921. Date of Electronic Publication: 2020 Aug 09.
DOI: 10.1111/pace.13992
Abstrakt: Background: Cardiac amyloidosis is a progressive infiltrative disease involving deposition of amyloid fibrils in the myocardium and cardiac conduction system that frequently manifests with heart failure (HF) and arrhythmias, most frequently atrial fibrillation (AF), atrial flutter (AFL), and atrial tachycardia (AT).
Methods: We performed an observational retrospective study of patients with a diagnosis of cardiac amyloid who underwent catheter ablation at our institution between January 1, 2011 and December 1, 2018. Patient demographics, procedural characteristics, and outcomes were determined by manual chart review.
Results: A total of 13 catheter ablations were performed over the study period in patients with cardiac amyloidosis, including 10 AT/AF/AFL ablations and three atrioventricular nodal ablations. Left ventricular ejection fraction was lower at the time of AV node ablation than catheter ablation of AT/AF/AFL (23% vs 40%, P = .003). Cardiac amyloid was diagnosed based on the results of preablation cardiac MRI results in the majority of patients (n = 7, 70%). The HV interval was prolonged at 60 ± 15 ms and did not differ significantly between AV nodal ablation patients and AT/AF/AFL ablation patients (69 ± 18 ms vs 57 ± 14 ms, P = .36). The majority of patients undergoing AT/AF/AFL ablation had persistent AF (n = 7, 70%) and NYHA class II (n = 5, 50%) or III (n = 5, 50%) HF symptoms, whereas patients undergoing AV node ablation were more likely to have class IV HF (n = 2, 66%, P = .014). Arrhythmia-free survival in CA patients after catheter ablation of AT/AF/AFL was 40% at 1 year and 20% at 2 years.
Conclusions: Catheter ablation of AT/AF/AFL may be a feasible strategy for appropriately selected patients with early to mid-stage CA, whereas AV node ablation may be more appropriate in patients with advanced-stage CA.
(© 2020 Wiley Periodicals LLC.)
Databáze: MEDLINE
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