Send to

Choose Destination
J Am Coll Cardiol. 2019 Nov 5;74(18):2267-2274. doi: 10.1016/j.jacc.2019.08.1045.

Direct Current Cardioversion of Atrial Fibrillation in Patients With Left Atrial Appendage Occlusion Devices.

Author information

Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas.
Icahn School of Medicine at Mount Sinai, New York, New York.
Cedars-Sinai Medical Center, Los Angeles, California.
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
Texas Heart Institute, St. Luke's Hospital, Houston, Texas.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas. Electronic address:



Direct current cardioversion (DCCV) is a common rhythm control strategy in patients with symptomatic atrial fibrillation or flutter. There is no long-term data regarding the safety of DCCV in patients with endocardial left atrial appendage occlusion (LAAO) devices.


The purpose of this study was to assess the feasibility and safety of DCCV in patients with an LAAO device.


This multicenter retrospective study included 148 patients with an LAAO device who underwent DCCV for symptomatic atrial fibrillation or atrial flutter.


The average age of the included patients was 72 ± 7 years and 59% were men. All patients (100%) had a transesophageal echocardiogram prior to DCCV. Device-related thrombus was seen in 2.7%. They were all successfully treated with oral anticoagulation (OAC) and were able to undergo DCCV after 6 to 8 weeks. DCCV restored sinus rhythm in all patients. None of the patients had DCCV-related thromboembolic complications. A total of 22% of patients were newly started on OAC after DCCV. There was no difference in DCCV-related complications between patients treated with or without OAC post-DCCV. Patients receiving OAC post-DCCV were found to undergo cardioversion at an earlier time after implantation (3.6 months [interquartile range (IQR): 0.7 to 8.6 months] vs. 8.6 months [IQR: 2.5 to 13.3 months]; p = 0.003). Three transient ischemic attacks, unrelated to DCCV, were found during follow-up. During a median follow-up of 12.8 months (IQR: 11.8 to 14.2 months), no device or left atrial thrombosis, device dislodgement, or a new device leak were observed. One patient died during follow-up due to noncardiac cause.


DCCV is feasible in high-risk AF patients with an LAAO device without the need for oral anticoagulation if pre-procedural transesophageal echocardiography shows good device position, absence of device-related thrombus, and peridevice leak of ≤5 mm. The preliminary results are encouraging, but further large studies are warranted to establish safety.


Watchman; direct current cardioversion; left atrial appendage occlusion; oral anticoagulation

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center