Login
Search
Search
0 Dates
2024
2023
2022
2021
2020
2019
2018
0 Events
CPC 2018
CPC 2019
Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
CPC 2020
CPC 2021
CPC 2022
CPC 2023
CPC 2024
0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
O. Basic Science
P. Other
0 Themes
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)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
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
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
0 Resources
Abstract
Slides
Vídeo
Report
CLEAR FILTERS
PVI only versus PVI with complementing strategies – less is more
Session:
Posters - C. Arrhythmias and Device Therapy
Speaker:
Mafalda Carrington
Congress:
CPC 2021
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Posters
FP Number:
---
Authors:
Mafalda Carrington; Joana Brito; Pedro Silvério António; Afonso Nunes-Ferreira; Tiago Rodrigues; Rita Rocha; Beatriz Silva; Ana Bernardes; Nuno Cortez-Dias; Fausto j Pinto; João de Sousa
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>The cornerstone of atrial fibrillation (AF) catheter ablation (CA) is the complete pulmonary veins isolation (PVI), applying circular lesions around their antrum. Particularly in persistent and long-standing persistent AF, more extensive ablation has been advocated, which may include empirical additional linear lesions in the left atrium (LAL). Moreover, cavo-tricuspid isthmus ablation (CTA) may be performed even in the absence of previous atrial flutter (AFL). However, additional benefit versus PVI alone, justifying its use during the first procedure, is yet to be confirmed. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose: </strong>To compare arrhythmia-free survival between PVI alone versus PVI complemented with LAL and/or CTA. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> This was a single-center prospective study of patients submitted to CA between 2004 and 2020. We included all patients with AF who were submitted to a first point-by-point CA, with or without LAL or CTA. We excluded all patients that presented a history of atypical flutter. Patients were monitored with Holter/event monitors periodically performed after ablation at 6 and 12 months and then annually until completing 5 years of follow-up. Our primary endpoint was arrhythmia-free survival, defined as the absence of documentation of more than 30 seconds of AF, flutter or atrial tachycardia during ambulatory monitoring. Cox regression and Kaplan-Meier survival were used to compare the success of ablation as a function of the clinical type of AF.</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 293 patients were included, submitted to CA between 2004 and 2018. In this cohort, there were 64.5% males (n=189) and the mean age was 58±13 years-old. The indications for CA were distributed as follows: paroxysmal AF in 60.1% (n=176), persistent in 28.3% (n=83) and long-standing persistent in 11.6% (n=34). In addition, 38.8% (n=106) of the patients had a previous history of typical atrial flutter. CA by PVI was performed in all patients, and it was complemented with LAL in 47 (16%) patients and with CTA in 83 (28.3%). The 12 and 36-months CA success rate were 70.8% and 52.9%, and there were significant differences depending on the ablation strategy. The 36-months success rate 60.6% in patients submitted to PVI only strategy and 40,7% when PVI and CTA were performed (non-significant difference, P=0.078). However, the risk of AF recurrence was 2 times superior in patients submitted to PVI and LAL strategy (HR: 2.27; IC95% 1.38-3.75; P=0.001) and 4 times superior in those with a strategy with PVI+CTA+LAL (HR: 4.17; IC95% 1.79-9.72; P=0.001), when compared to the PVI only group (Figure 1). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions: </strong>Treating AF with CA therapy using PVI alone was superior to a strategy with combined LAL and to CTA and LAL. A LAL strategy seemed to adversely affect the long-term success rate.</span></span></p>
Slides
Our mission: To reduce the burden of cardiovascular disease
Visit our site