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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
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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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Very long-term outcomes after a single catheter ablation procedure for the treatment of atrial fibrillation – the protective role of antiarrhythmic drug therapy
Session:
Posters 4 - Écran 08 - Arritmologia Invasiva
Speaker:
João Pedro Vilaça Delgado de Almeida e Mesquita
Congress:
CPC 2018
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Posters
FP Number:
---
Authors:
João Mesquita; Diogo Cavaco; António Ferreira; Elisabete Vaz; Francisco Moscoso Costa; Pedro Lopes Do Carmo; Francisco Bello Morgado; Miguel Mendes; Pedro Adragão
Abstract
<h3><strong>Background: </strong></h3> <p>Pulmonary vein isolation (PVI) is the cornerstone of AF ablation but its long-term clinical outcomes, predictors of relapse and optimal pharmacological treatment remain controversial.</p> <h3><br /> <strong>Objective</strong>: </h3> <p>To (1) assess very long-term AF recurrence, identify predictors of relapse, and (2) evaluate the impact of continued antiarrhythmic drug (AAD) treatment after ablation.</p> <h3><br /> <strong>Methods: </strong></h3> <p>Multicenter observational registry including all consecutive patients with drug-resistant AF who underwent a first PVI between 2006-2008 (n=253 (age 55 years (IQR 48-63), 80% males, 64% with paroxysmal AF (Fig A)). Endpoint was AF/AT/AFL relapse after a 3-month blanking period. Predictors and protective factors of AF relapse were assessed with multivariate Cox regression.</p> <h3><br /> <strong>Results: </strong></h3> <p>144 patients (57%) relapsed over a median 5-year (IQR 2-9) follow-up - annual relapse rate of 10%/year. Female sex (aHR 1.526, 95% CI 1.037-2.246, P=0.032), non-paroxysmal AF (aHR 1.410, 95% CI 1.000-1.987, P=0.050) and LA volume/BSA (aHR 1.012, 95% CI 1.003-1.021, P=0.008) were identified as independent predictors of relapse. 139 patients (55%) continued AAD (55% on amiodarone) after blanking period. 1-year overall PVI success rate of patients under AAD was 86% vs 76% with no AAD (P<0.001) - annual relapse rates were 8%/year vs 14%/year (P<0.001), respectively (Fig B). AAD was associated with a long-term reduction in AF relapse (aHR 0.673, 95% CI 0.509-0.904 P=0.004).</p> <h3><br /> <strong>Conclusion: </strong></h3> <p>Half the patients remained free from AF 5 years after a single procedure. Female sex, non-paroxysmal AF and LA volume/BSA independently predicted recurrence, whereas continuing AAD after the 3-month blanking period reduced relapse.</p>
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