1. Atrial fibrillation in the setting of cardiac amyloidosis - A review of the literature.
- Author
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Bazoukis G, Saplaouras A, Efthymiou P, Yiannikourides A, Liu T, Sfairopoulos D, Korantzopoulos P, Varrias D, Letsas KP, Thomopoulos C, Tse G, and Stavrakis S
- Subjects
- Humans, Cardiomyopathies etiology, Cardiomyopathies therapy, Amyloid Neuropathies, Familial complications, Amyloid Neuropathies, Familial therapy, Catheter Ablation, Immunoglobulin Light-chain Amyloidosis complications, Immunoglobulin Light-chain Amyloidosis therapy, Immunoglobulin Light-chain Amyloidosis diagnosis, Amyloidosis therapy, Amyloidosis complications, Amyloidosis etiology, Anticoagulants therapeutic use, Thromboembolism etiology, Electric Countershock, Atrial Fibrillation etiology, Atrial Fibrillation therapy, Atrial Fibrillation complications
- Abstract
Cardiac amyloidosis (CA) is related to the aggregation of insoluble fibrous deposits of misfolded proteins within the myocardium. Transthyretin amyloidosis (ATTR) and immunoglobulin light-chain amyloidosis are the main forms of CA. Atrial fibrillation (AF) is a common arrhythmia in CA patients, especially in those with ATTR amyloidosis. Increased atrial preload and afterload, atrial enlargement, enhanced atrial wall stress, and autonomic dysfunction are the main mechanisms of AF in CA patients. CA is associated with the formation of endocardial thrombi and systemic embolism. The promoters of thrombogenesis include endomyocardial damage, blood stasis, and hypercoagulability. The prevalence of thrombi in patients with AF remains elevated despite long-term anticoagulation. Consequently, transesophageal ultrasound examinations before cardioversion should be performed to exclude endocardiac thrombi despite anticoagulation. Furthermore, the CHA
2 DS2 -VASc score should not be used to assess the thromboembolic risk in CA patients with AF. Rate control is challenging in patients with CA, while rhythm control is the preferred treatment option, especially in the early stages of the disease process. Although catheter ablation is an effective treatment option, more data are needed to explore the role of the procedure in CA patients., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)- Published
- 2024
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