TY - JOUR
T1 - Epidemiology, Mechanisms, and Management of Atrial Fibrillation in Cardiac Amyloidosis
AU - Bukhari, Syed
AU - Oliveros, Estefania
AU - Parekh, Harshal
AU - Farmakis, Dimitrios
N1 - Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2023/4
Y1 - 2023/4
N2 - Cardiac amyloidosis (CA) is a restrictive disease that results from intramyocardial amyloid deposition due to immunoglobulin light chain or transthyretin proteins. Up to two-third of CA patients have atrial fibrillation (AF) due to electromechanical, autonomic, and hemodynamic disturbances. AF in CA carries particularly increased risk of thromboembolism, prompting anticoagulation therapy irrespective of CHA2DS2VASc score. However, CA is also associated with enhanced bleeding risk that warrants thorough assessment of bleeding profile before initiation of anticoagulation. Management of AF in CA is challenging because these patients poorly tolerate rate control agents, while cardiomyopathy precludes most antiarrhythmic agents, leaving amiodarone as the preferred antiarrhythmic drug. The effectiveness of direct current cardioversion in restoring sinus rhythm in CA is comparable with that in the general population, although intraprocedural complication rates could be higher. Transesophageal echocardiogram should be performed prior to direct current cardioversion, given high incidence of intracardiac thrombus in these patients. Finally, the data on catheter ablation is limited.
AB - Cardiac amyloidosis (CA) is a restrictive disease that results from intramyocardial amyloid deposition due to immunoglobulin light chain or transthyretin proteins. Up to two-third of CA patients have atrial fibrillation (AF) due to electromechanical, autonomic, and hemodynamic disturbances. AF in CA carries particularly increased risk of thromboembolism, prompting anticoagulation therapy irrespective of CHA2DS2VASc score. However, CA is also associated with enhanced bleeding risk that warrants thorough assessment of bleeding profile before initiation of anticoagulation. Management of AF in CA is challenging because these patients poorly tolerate rate control agents, while cardiomyopathy precludes most antiarrhythmic agents, leaving amiodarone as the preferred antiarrhythmic drug. The effectiveness of direct current cardioversion in restoring sinus rhythm in CA is comparable with that in the general population, although intraprocedural complication rates could be higher. Transesophageal echocardiogram should be performed prior to direct current cardioversion, given high incidence of intracardiac thrombus in these patients. Finally, the data on catheter ablation is limited.
UR - http://www.scopus.com/inward/record.url?scp=85146468363&partnerID=8YFLogxK
U2 - 10.1016/j.cpcardiol.2022.101571
DO - 10.1016/j.cpcardiol.2022.101571
M3 - Review article
C2 - 36584731
AN - SCOPUS:85146468363
SN - 0146-2806
VL - 48
JO - Current Problems in Cardiology
JF - Current Problems in Cardiology
IS - 4
M1 - 101571
ER -