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Arrhythmia-induced cardiomyopathy: unveiled after electrical cardioversion
Session:
Posters - C. Arrhythmias and Device Therapy
Speaker:
Raquel Menezes Fernandes
Congress:
CPC 2021
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.8 Atrial Fibrillation - Clinical
Session Type:
Posters
FP Number:
---
Authors:
Raquel Menezes Fernandes; Teresa Mota; Hugo Costa; Miguel Espírito Santo; Dina Bento; Rui Candeias; Jorge Mimoso; Ilídio Jesus
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> Arrhythmia-induced cardiomyopathy (AIC) is an important cause of left ventricular (LV) dysfunction, confirmed by the reversal of cardiomyopathy after controlling the arrhythmia. It requires a high index of suspicion.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose: </strong>To determine the prevalence and prognosis of AIC in patients referred to electrical cardioversion (EC) due to atrial fibrillation (AF) or atrial flutter (AFL).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>We conducted a retrospective study encompassing patients referred to EC due to AF/AFL in our Cardiology Department, from September 2011 to September 2020. Clinical characteristics, echocardiographic studies and follow-up data were analysed. Reduced LV ejection fraction (LVEF) was defined as LVEF lower than 50%. Primary endpoints were all-cause mortality and cardiovascular (CV) death. We excluded patients with no information regarding LVEF before and after the EC. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> A total of 719 patients were referred to EC during the 9-year period, with a median age of 67 years-old and 70,4% male predominance. EC was successfully performed in 93,2%. Regarding patients with LVEF data, only 123 patients (28,9%) had reduced LVEF before EC. Of these, 24,4% of patients were diagnosed with AFL, 59,3% had arterial hypertension, 26,9% were obese, 24,4% had ischemic heart disease and 7,3% had sleep apnea. Persistent AF/AFL was identified in 60,3%, 23,1% presented with first diagnosed AF/AFL and 15,7% had paroxysmal episodes. 57 patients (46,3%) had documented reversal of LV dysfunction after EC (improvement of a median LVEF of 41% to 59% after EC), confirming AIC diagnosis. Comparing to patients who did not recover LV function after EC, AIC patients had a larger prevalence of persistent AF/ALF (75% vs 45,2%; p=0,01), were more frequently cardioverted in an outpatient setting (68,4% vs 46%; p=0,047) and had a lower prevalence of ischemic heart disease (5,3% vs 42,9%; p<0,001) and stroke (1,8% vs 12,7%; p=0,023). They also had lower values of CHA2DS2-VASc (2,23 vs 3,19; p<0,001) and HAS-BLED scores (0,6 vs 1,03; p=0,005) and were more treated with direct oral anticoagulants (77,8% vs 54,5%; p=0,01) than vitamin K antagonists. 64,6% remained in sinus rhythm one year after EC (vs 42,6%; p=0,026). During a median follow-up of 1338 days, no significant differences were found regarding all-cause mortality, but we report a lower rate of CV death in AIC patients (3,8% vs 25,5%; p=0,002).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>In our study, 46,3% of patients with reduced LVEF had AIC, which was associated with a significantly lower rate of CV death. Given the prognostic impact of this diagnosis, EC should be considered as a primary strategy in patients with high suspicion of AIC due to AF/AFL.</span></span></p>
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