Atrial Fibrillation in Transthyretin Cardiac Amyloidosis
| Autor: | Eoin Donnellan, Sneha Vakamudi, Divyang Patel, Oussama M. Wazni, Mohamed B. Elshazly, Daniel J. Cantillon, Thomas Dresing, Rishi Puri, Mazen Hanna, Mohamed Kanj, Wael A. Jaber, Walid Saliba, Bryan Baranowski |
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| Rok vydání: | 2020 |
| Předmět: |
Tafamidis
education.field_of_study medicine.medical_specialty business.industry medicine.medical_treatment Population Atrial fibrillation Retrospective cohort study 030204 cardiovascular system & hematology medicine.disease Cardioversion 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine chemistry Cardiac amyloidosis Internal medicine Heart failure Cohort medicine Cardiology 030212 general & internal medicine education business |
| Zdroj: | JACC: Clinical Electrophysiology. 6:1118-1127 |
| ISSN: | 2405-500X |
| DOI: | 10.1016/j.jacep.2020.04.019 |
| Popis: | Objectives This study sought to determine the incidence and prevalence of atrial fibrillation (AF) in transthyretin cardiac amyloidosis (ATTR-CA); to study the factors associated with the development of AF in this population; to study the prognostic implications of AF and maintenance of normal sinus rhythm (NSR) in patients with ATTR-CA; and to determine the impact of ATTR-CA stage on AF prevalence, outcomes, and efficacy of rhythm control strategies. Background AF is common in patients with ATTR-CA. The aim of this study was to determine the predictors, prevalence, and outcomes of AF in patients with ATTR-CA in addition to the efficacy of rhythm control strategies. Methods This was a retrospective cohort study of 382 patients with ATTR-CA diagnosed at our institution between January 2004 and January 2018. Means testing, and univariable and multivariable models were used. Results AF occurred in 265 (69%) patients. Factors associated with the development of AF included older age, advanced ATTR-CA stage, and higher left atrial volume index. Antiarrhythmic therapy (AAT) was used in 35% of patients with AF; cardioversion was performed in 45%, and 5% underwent AF ablation. Rhythm control strategies were substantially more effective when performed earlier in the disease course. During a mean follow-up of 35 months, no difference in mortality between patients with AF and those without AF was observed (65% vs. 49%; p = 0.76). On Cox proportional hazards analyses, maintenance of normal sinus rhythm and tafamidis use were associated with improved survival, whereas advanced ATTR-CA stage and higher New York Heart Association functional class were associated with increased mortality. Conclusions With advancing ATTR-CA stage, AF became more prevalent, occurring in 69% of our entire study cohort. Rhythm control strategies including AAT, direct-current cardioversion, and AF ablation were substantially more effective when performed earlier during the disease course. |
| Databáze: | OpenAIRE |
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