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A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
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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)
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15. Valvular Heart Disease
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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
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Validation of the ATLAS score in patients undergoing pulmonary vein isolation following a previous relapse
Session:
Posters 5 - Écran 09 - Arritmologia
Speaker:
Daniel Jorge Nascimento Matos
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:
Daniel Nascimento Matos; João Mesquita; António Ferreira; Francisco Fernandes Gama; Francisco Moscoso Costa; Pedro Lopes Do Carmo; Diogo Cavaco; Francisco Bello Morgado; Miguel Mendes; Pedro Adragão
Abstract
<p><strong>Introduction: </strong>Although pulmonary vein isolation (PVI) remains the cornerstone for the treatment of atrial fibrillation (AF), recurrence rates frequently offset the potential benefit of this procedure. The ATLAS score assesses each patient’s individual risk of relapse after a first PVI and aims at improving patient selection, but its clinical relevance for repeated (REDO) procedures remains undetermined.</p> <p><strong>Objective: </strong>Validate the ATLAS score in patients undergoing a REDO PVI.</p> <p><strong>Methods: </strong>From a single-center observational registry that included 1244 consecutive drug-resistant AF patients who underwent PVI, we selected those receiving REDO procedures and calculated their respective ATLAS score. The study endpoint was AF recurrence, defined as symptomatic or documented AF and other atrial arrhythmias, after a 3-month blanking period. Independent predictors of relapse were identified using Cox proportional-hazard regression analysis.</p> <p><strong>Results</strong>: Study population of 240 individuals (61 years old (IQR 53-67), 32% females, 65% with paroxysmal AF – <strong>Fig A</strong>). During a median 2-year follow-up period, 115 (48%) patients relapsed – annual relapse rate 16%/year. Non-paroxysmal AF (aHR 1.86 95% CI 1.27-2.70, P=0.001), body mass index (aHR 1.05 95% CI 1.01-1.10, P=0.033), female gender (aHR 1.92 95% CI 1.29-2.85, P=0.001) and active smoking (aHR 2.16 95% CI 1.35-3.46, P=0.001) were identified as independent predictors of relapse. The ATLAS score was also associated with AF relapse (HR 1.11 95% CI 1.07-1.16, P<0.001). A revised threshold of low (<7 points), intermediate (7-10 points) and high-risk (>10 points) score yielded the highest discriminative power (censored C statistic = 0.73), with 10%/year, 15%/year and 23%/year relapse rates, respectively (Log-rank 9.9, P=0.008, <strong>Fig B</strong>).</p> <p><strong>Conclusion</strong>: The ATLAS score seems to be valid to assess the risk of AF relapse of patients undergoing a repeated ablation procedure. This score retains its clinical usefulness for selecting patients who will benefit the most from AF ablation, avoiding the unnecessary risks and costs of ineffective procedures.</p>
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