医学
心房颤动
心脏病学
内科学
窦性心律
心脏复律
心脏淀粉样变性
导管消融
胺碘酮
心房颤动的处理
人口
心肌病
淀粉样变性
心力衰竭
环境卫生
作者
Syed Bukhari,Estefanía Oliveros,Harshal Parekh,Dimitrios Farmakis
标识
DOI:10.1016/j.cpcardiol.2022.101571
摘要
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.
科研通智能强力驱动
Strongly Powered by AbleSci AI