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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
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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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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Cardiac Resynchronization Therapy evalutation in patients in sinus rhythm compared with patients with atrial fibrillation
Session:
Posters 5 - Écran 4 - Arritmologia
Speaker:
Alexandra Briosa
Congress:
CPC 2019
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Posters
FP Number:
---
Authors:
A. Briosa; Ana Rita F. Pereira; Ana I. Marques; Daniel Sebaiti; Sofia Alegria; Ana Catarina Gomes; R. Miranda; Sofia Almeida; L. Brandao; H. Pereira
Abstract
<p><strong>Introduction</strong>: Heart failure (HF) and atrial fibrillation (AF) are two increasingly prevalent conditions that frequently coexist. Cardiac Resynchronization Therapy (CRT) has shown to improve the outcome in selected patients with HF, however AF may have a negative impact on this population.</p> <p><strong>Purpose</strong>: To characterize patients (pts) who were submitted to CRT implantation in SR vs AF and to analyse the differences in long term outcomes (responders, hospitalizations and mortality) between both groups.</p> <p><strong>Methods</strong>: Retrospective study of a single center analyzing patients submitted to CRT implantation in the last 6 years (2012-2018). Clinical and imaging data were collected, as well as long term outcomes concerning hospitalization, mortality and response. Responders were defined as pts who improved >=1 NYHA class or/and > 10% left ventricular ejection fraction (LVEF).</p> <p><strong>Results</strong>: We analysed 103 pts, 65% males with mean age of 70± 10 years, with optimized medical treatment. Non ischemic cardiomyopathy was present in 74,5% of pts. 68,1% pts had QRS > 150ms and 80,9% had left bundle brunch block (LBBB). Mean LVEF was 27,9±7,5%, mean left ventricular end-diastolic volume índex (LVEDVI) was 113± 38 ml/m2. By the time of CRT implantation, 67% of pts were in SR (n=69) and 33% had AF (13,6% with paroxystic AF and 19,4% with persistent AF), and NYHA class 3 was present in 56,3% of pts. 76,7% of pts were considered responders. Subsequent hospitalizations occurred in 18,4%, and 11 pts died. 5 were submitted to atrialventricular node (AVN) ablation (4,9%).</p> <p>After implantation, pts with AF rhythm had less biventricular pacing percentage (BIV) (p<0,001) and higher functional class (p=0,007).</p> <p>Although there were no difference between both groups concerning HF hospitalizations (p=0,699), AF hospitalizations (p=0,597), mortality due to HF (p=0,253) and overall survival (log rank=0,187 p= 0,66), pts with AF were considered less responders (61,5% vs 83,3% p=0,028). When comparing pts with AF submitted to NAV ablation and AF not submited to ablation, there was a tendency for an improved response in pts undergoing NAV ablation.</p> <p><strong>Conclusion</strong>: The proportion of responders to CRT implantation was lower in AF pts, although no differences in hospitalizations, mortality and overall survival were found between SR and AF pts. Given the lower number of NAV ablation in AF pts receiving CRT in our center, this could explain the lower rate of responders in this population compared with pts in SR.</p>
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