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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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A. Basics
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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
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15. Valvular Heart Disease
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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
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34. Public Health and Health Economics
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Subclinical atrial fibrillation: more than a higher risk for stroke?
Session:
CO10 - Arritmologia
Speaker:
Rita Marinheiro
Congress:
CPC 2019
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.1 Antibradycardia Pacing
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Rita Marinheiro; Leonor Parreira; Pedro Campos Amador; Claudia Lopes; Andreia Cristina Serrano Fernandes; Dinis Valbom Mesquita; Marta Ferreira Fonseca; José Maria Farinha; Ana Fátima Esteves; Antonio Pinheiro Cumena Candjondjo; Jose Venancio; Rui Caria
Abstract
<p><strong>Introduction</strong><strong>:</strong> Subclinical atrial fibrillation (sAF) is common in pacemaker patients and it has been demonstrated to increase the risk of stroke. However, there is not always a temporal relationship between sAF and stroke occurrence, suggesting sAF can be just a marker of stroke risk and be related with other concomitant cardiovascular (CV) diseases.</p> <p> </p> <p><strong>Aim:</strong> To compare patients with sAF to those without it in what concerns baseline CV risk factors and also clinical outcomes (AF, heart failure (HF), cardiovascular (CV) death and overall death) during the follow-up.</p> <p> </p> <p><strong>Methods:</strong> From 2014 to 2017 we selected patients with pacemaker and without prior diagnosis of AF, in whom sAF was detected. sAF was defined as atrial high-rate episodes (>6 minutes and < 24-hours) with lack of correlated symptoms, detected with continuous intracardiac ECG monitoring. We used an age- and gender-matched population with pacemaker but no sAF as a control group. During the follow-up, we analysed future development of AF (in ECG or Holter monitoring), admissions for new-onset HF with reduced (HFrEF), mid-range (HFmrEF) or preserved ejection fraction (HFpEF) (admission with new or increasing symptoms or signs of the disorder), CV death and overall death. Since a proportion of patients with sAF initiated oral anticoagulation, according to current AF guidelines, we were not able to compare ischemic events in the 2 groups.</p> <p> </p> <p><strong>Results:</strong> We studied 172 patients: 86 with sAF and 86 with no sAF (control group). Baseline characteristics were not different between the groups, except for indexed left atrium volume - 40 mL (IQR: 34-50) in sAF group versus 35 mL (IQR: 34-40) in control group (p=0.01) (figure 1A). During a mean follow-up of 24±10 months, 32 patients (37%) had AF in the sAF group, comparing to 6 (7%) in the control group (Hazard ratio (HR) 5.6, 95% confidence interval (CI) 2.3-13.4, p<0.001) and 35 patients (41%) had new-onset HF in the sAF group (32 with HFpEF; 3 HFmrEF), comparing to 9 (10%) in the control group (8 with HFpEF; 1 HFmrEF) (HR 2.1, 95% CI1.0-4.7, p=0.05). No interaction was found between AF and new-onset HF (p=0.46). The risk of CV death and overall death was not significantly different between the two groups. Rate per 100-person-years and HR are presented in figure 1B. Kaplan-Meier survival curves are presented in figures 1C, 1D and 1E.</p> <p> </p> <p><strong>Conclusion:</strong> In this group of patients with pacemakers, the presence of sAF was useful for predicting the future development of AF and new-onset HF. sAF is possibly a marker of electrophysiological atrial remodeling, predicting the future development of AF and HF. Indeed, it is of paramount importance to monitor sAF patients more closely, not only due to AF and stroke risk, but also due to HF, even in the presence of a normal EF. Death was not different between the groups, probably due to the short time of follow-up.</p>
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