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CPC 2018
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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
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0 Themes
01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
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Anticoagulation and antiarrhythmic strategies used in the treatment of Atrial Fibrillation in Hypertrophic Cardiomyopathy: results from the Portuguese Registry
Session:
Posters 2 - Écran 09 - Miocárdio e Pericárdio
Speaker:
Ana Lebreiro
Congress:
CPC 2018
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.4 Myocardial Disease – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Ana Margarida Lebreiro; Elisabete Martins; Alexandra Sousa; Carla De Sousa; Sérgio Machado Leite; Maria Júlia Maciel Barbosa; Em nome dos investigadores do Registo de Miocardiopatia Hipertrófica
Abstract
<p>Background: All patients (pts) with Hypertrophic Cardiomyopathy (HCM) developing atrial fibrillation (AF) are considered to be at high risk of thromboembolic events. However, a consensus on what constitutes an increased risk of stroke in the HCM population has yet to be clarified. Which anticoagulation strategy should be followed, is also a matter of debate. The most recent ESC guidelines discussing this patient group were the first to recommend the use of either vitamin K antagonists or DOAC as anticoagulation.</p> <p>Aim: We proposed to analyse the Portuguese registry of HCM with regards to the presence of AF, identifying risk factors and the anticoagulation and antiarrhythmic strategy adopted.</p> <p>Methods: The Portuguese Registry of HCM was analysed. 809 adult pts, all with phenotype of HCM and at least one 24h Holter monitoring were selected. Their risk factors and treatment strategies regarding antiarrhythmic drugs and anticoagulation were assessed. A comparison between pts with and without AF was carried when appropriate and differences with p values <.05 were considered significant.</p> <p>Results: AF was documented in 14.6% of pts (62.7% male), with no gender differences between groups (p=0.4). Pts with AF were older (58 vs 51y, p<.01) and more often symptomatic (68.4% vs 52.9%, p=.007) at the time of HCM diagnosis, and were more likely to have LVF impairment (13.8% vs 3.2%, p<.01) and cerebrovascular disease (8% vs 2.1%, p<.01). Hypertension did not differ between groups (46.2% vs 43.6%, p=0.6) nor did the presence of coronary artery disease (4.5% vs 4.6%, p=0.9). LA diameters (51.1 vs 42.2 mm, p<.01) and volumes (58.8 vs 43.3 mL, p<.01) were higher among pts with AF, while presence of dynamic intraventricular or LV outflow obstruction did not differ between groups (52.7% vs 48.3%, p=0.07 and 55.9% vs 54.3%, p=0.8). Pts with AF were more frequently treated with b blockers (82.2% vs 73.6%, p=0.048), nondihydropyridine calcium channel blockers (10.4% vs 5.1%, p=0.02) and amiodarone (33.6% vs 11.8%, p<.01). 88.7% of pts with documented AF were anticoagulated: the vast majority with vitamin K antagonist, 71.3%, 10.4% with dabigatran, 2.6% with rivaroxaban and 4.3% with apixaban.</p> <p>Conclusion: Despite recent recommendations regarding the use of DOACS, these pts are still mainly anticoagulated with vitamin K antagonists. We also found that amiodarone is used in more than a third of pts with AF, although they tend to be relatively young and a prolonged exposure to this drug can be anticipated. We believe that emerging evidence supporting the use of DOACS and catheter ablation strategies can change our current approach to AF management in pts with HCM. </p>
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