Direct current cardioversion feasible for high-risk AF patients with LAAO devices

High-risk atrial fibrillation (AF) patients with an endocardial left atrial appendage occlusion (LAAO) device may undergo direct current cardioversion (DCCV) without the need for oral anticoagulation (OAC) if preprocedural trans-oesophageal echocardiography shows good device position, suggests a study.

“DCCV is a common rhythm control strategy in patients with symptomatic AF or [atrial] flutter,” the authors said.

A total of 148 patients (mean age, 72±7 years; 59 percent men) with an LAAO device who underwent DCCV for symptomatic AF or atrial flutter were included in this multicentre retrospective study. All patients (100 percent) had a trans-oesophageal echocardiogram prior to DCCV.

Of the patients, 2.7 percent had device-related thrombus. All of them were successfully treated with OAC and were able to undergo DCCV after 6–8 weeks. Sinus rhythm was restored in all patients, and none suffered from DCCV-related thromboembolic complications.

About one in five patients (22 percent) were newly started on OAC after DCCV. No difference in DCCV-related complications was found between patients treated with or without OAC after DCCV. Patients on OAC post-DCCV underwent cardioversion at an earlier time following implantation (3.6 vs 8.6 months; p=0.003).

During follow-up, three transient ischaemic attacks occurred but were unrelated to DCCV. There were no device or left atrial thrombosis, device dislodgement, or new device leak seen during a median follow-up of 12.8 months (interquartile range, 11.8–14.2 months). Unfortunately, one patient died due to a noncardiac cause during follow-up.

“The preliminary results are encouraging, but further large studies are warranted to establish safety,” the authors said.