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A. Basics
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01. History of Cardiology
02. Clinical Skills
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05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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Does atrial fibrillation have a long-term prognostic impact in ICD patients?
Session:
Painel 4 - Arritmologia 5
Speaker:
Pedro Morais
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.2 Atrial Fibrillation - Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Pedro Morais; Afonso Nunes Ferreira; GUSTAVO SILVA; Mafalda Carrington; Joana Brito; Andreia Magalhães; Sara Couto Pereira; João Rodrigues De Sousa; Pedro Nuno Carlos Marques
Abstract
<p><strong>Introduction</strong>:</p> <p>Implantable Cardioverter Defibrillators (ICD) may be indicated for secondary prevention of sudden cardiac death (SCD) or for primary prevention in patients with ischaemic (i-CMP) and dilated noni-CMP with low ejection fraction (EF) and in selected patients with other CMP and channelopathies. Atrial fibrillation (AF) is a very common comorbidity in these patients. There is increasing evidence showing that AF may also be associated with higher overall mortality and (in)appropriate shock therapy, however the benefits of ICD in these patients comparing to patients in sinus rhythm are not fully established.</p> <p><strong>Purpose</strong>:<br /> To compare the prognostic impact of ICD in patients with and without AF.</p> <p><strong>Methods</strong>:</p> <p>Prospective single-center study of patients who implanted ICD between 2015 and 2019. Clinical characteristics were evaluated at baseline and mortality was assessed using the national registry. We performed univariate and multivariate analysis to compare clinical characteristics of patients with and without AF. Prognostic impact of ICD was evaluated by comparing total mortality using the Cox regression and Kaplan-Meier methods.</p> <p><strong>Results</strong>:</p> <p>From 2015-2019, 414 ICDs were implanted (81% male, 62±12 years old, follow-up duration 23[11-41] months). Among these patients, 86 patients (21%) had AF (85% males, mean age 76±10 years, 53% ischemic, 58% secondary prevention and 85% with LVEF<=40). The cardiovascular risk factors and comorbidities were similar in both populations (with and without AF), except for diabetes mellitus (45% vs 32%, p=0.027) which was more frequent in AF patients.</p> <p>After adjusting for diabetes (HR 1.64; 95%CI 0.92-2.91, p=0.092) and dilated noni-CMP (HR 0.61; 95%CI 0.28-1.33, p=0.213), we found that all-cause mortality remained similar between both groups (HR 0.93; 95%CI 0.47-1.84, p=0.832).</p> <p><strong>Conclusions</strong>:</p> <p>In our cohort of patients who underwent ICD implantation, we found that mortality is similar between patients with AF and without AF and that diabetes, dilated noni-CMP and ventricular tachycardia ablation were independent predictor of all-cause mortality. Long-term survival in patients with an ICD was comparable between patients with and without AF.</p>
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