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Short- and long-term outcomes after radiofrequency catheter ablation of the His bundle: the experience of a Portuguese center.
Session:
Posters 3 - Écran 8 - Arritmologia
Speaker:
Ana Mosalina Soares Manuel
Congress:
CPC 2019
Topic:
C. Arrhythmias and Device Therapy
Theme:
04. Arrhythmias, General
Subtheme:
04.4 Arrhythmias, General – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Ana Mosalina; João Gonçalves Almeida; Paulo Fonseca; Cláudio Guerreiro; Joel Monteiro; Fernando Montenegro; José Ribeiro; Filipa Rosas; Elisabete Santos ; José Ribeiro; Marco André Oliveira; Helena Gonçalves; João Primo; Pedro Braga
Abstract
<p><strong>Background: </strong>In<strong> r</strong>efractory supraventricular arrhythmias (SA) with rapid ventricular rates and in systolic heart failure (HF) with need of biventricular pacing and high burden of atrial fibrilation (AF) despite a rhythm control approach, catheter ablation of the His bundle (AHB) may be performed. The purpose of this study was to assess outcomes of AHB and pacing therapy in these two conditions. </p> <p><strong> Methods: </strong>Patients referred for AHB from 1997 to 2018 were retrospectively included. Baseline clinical data, procedural variables and outcomes of AHB were collected.</p> <p><strong>Results: </strong>123 patients were included (69±9 years, 52% male). During a mean follow-up of 8.4 years, 28 patients died (23%). Patients presented advanced HF (NYHA class III - 42%, class IV – 3%), left ventricular disfunction (mean LVEF 47% ± 13), AF (65%) and rapid ventricular rates (mean heart rate 114 ± 33 bpm). Most of the patients needed hospital admission due to decompensated HF: once 31%, twice 20%, three or more times 9%. Devices were implanted before the procedure: pacemaker 82%, CRT-P 6%, CRT-D 8% and ICD 4%. AHB was performed in 113 patients at right side (91%) and in 13 patients at left side (11%). There were no procedure complications. At follow-up patients were less symptomatic (HF NYHA class III 8%, class IV 2%) and had fewer hospitalizations: once 9%, twice 1%, three or more times 4%. After univariate logistic regression, multiple emergency department visits due to HF (OR 58.7, 95% CI, 16.2-116.7, <em>p=0.004</em>), hospitalizations due to HF and the use spironolactone (OR, 268, 95% CI, 26.7 – 969.8, p<em>=0.017</em>) before the procedure, were found to be independent predictors of the composite endpoint after the procedure (death, hospitalization or emergency department visit due to decompensated HF). </p> <p><strong>Conclusion: </strong>His bundle ablation and pacing therapy is a safe and effective method to control heart rate in patients with supraventricular arrhythmias and rapid ventricular rates who have failed medical therapy.</p>
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