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Impact of atrial fibrillation and biventricular pacing percentage on long-term outcome in patients with heart failure treated with cardiac resynchronization therapy
Session:
Posters - C. Arrhythmias and Device Therapy
Speaker:
Tamara Pereira
Congress:
CPC 2021
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Posters
FP Number:
---
Authors:
Tamara Pereira; Pedro Von Hafe Leite; Geraldo Dias; Ana Filipa Cardoso; Mariana Tinoco; Olga Azevedo; Sílvia Ribeiro; Francisco Ferreira; Víctor Sanfins; António Lourenço
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">INTRODUCTION: A history of preoperative atrial fibrillation (AF) has been found to be associated with unfavorable outcomes, higher risks of non-response to cardiac resynchronization therapy (CRT) and loss of biventricular pacing (BivP). We aimed to assess the impact of AF and BivP on long-term outcomes in heart failure (HF) patients treated with CRT. </span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">METHODS: </span></span></span></span><span style="font-size:12.0pt"><span style="font-family:"Calibri Light",sans-serif">We retrospectively enrolled 227 patients undergoing CRT implantation between 2013 and 2020 according to the current <em>guidelines</em></span></span><span style="font-size:12.0pt"><span style="font-family:"Calibri Light",sans-serif">. 118 patients were included in our analysis, from whom all data were available. Clinical, electrocardiographic and echocardiographic parameters were evaluated at baseline and 6 months after CRT. Response to CRT was defined as an increase in left ventricular ejection fraction (LVEF) >10%. We considered an<span style="background-color:white"><span style="color:black"> effective delivery of BivP > 98%. </span></span>The<strong> </strong></span></span><span style="font-size:12.0pt"><span style="font-family:"Calibri Light",sans-serif">primary endpoint was the composite endpoint of hospitalization due to HF or death for any cause<strong>. </strong></span></span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">RESULTS: </span></span></span></span><span style="font-size:12.0pt"><span style="font-family:"Calibri Light",sans-serif">118 patients were included (mean age 69 ± 11 years, 66.1% males, 39.8% ischemic etiology; </span></span><span style="font-size:12.0pt"><span style="font-family:"Calibri Light",sans-serif">baseline LVEF was 27,6 ± 6%). Patients were divided into AF (n=42; 35,6%) and </span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Calibri Light",sans-serif">sinus rhythm</span></span></span><span style="font-size:12.0pt"><span style="font-family:"Calibri Light",sans-serif"> (SR)(n=76); 18 patients had permanent AF. AF patients had higher index </span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">left atrial volume and left ventricular mass</span></span></span></span><span style="font-size:12.0pt"><span style="font-family:"Calibri Light",sans-serif"> (p<0.001). M</span></span><span style="font-size:12.0pt"><span style="font-family:"Calibri Light",sans-serif">ean follow-up time was 43 ±18 months</span></span><span style="font-size:12.0pt"><span style="font-family:"Calibri Light",sans-serif">. BivP percentage was significantly superior in SR than in AF patients (98.1 </span></span><span style="font-size:12.0pt"><span style="font-family:"Calibri Light",sans-serif">± 2.1% vs 94.7 ± 4.5%, p< 0.001), </span></span><span style="font-size:12.0pt"><span style="font-family:"Calibri Light",sans-serif">with 75% of SR patients having <span style="background-color:white"><span style="color:black">BivP>98%</span></span></span></span><span style="font-size:12.0pt"><span style="font-family:"Calibri Light",sans-serif"> vs 30,3% of AF patients (p<0.001). There were no differences in preoperative </span></span><span style="font-size:12.0pt"><span style="font-family:"Calibri Light",sans-serif">parameters between them.</span></span><span style="font-size:12.0pt"><span style="font-family:"Calibri Light",sans-serif"> The response rate to CRT was higher in SR patients when compared to AF patients (63,2% vs 40,5%, p=0.021). Indeed, the variation of LVEF was higher in SR patients (12 ± 10% vs 7 ± 9%, p= 0.012).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Calibri Light",sans-serif">During follow-up, there were significant differences between AF and SR patients in the primary endpoint (73,8% vs 42,6%, p<0.001), and mortality for any cause (26,2% vs 9,2% p=0.014; p<0.001). </span></span><span style="font-size:12.0pt"><span style="font-family:"Calibri Light",sans-serif">In a multivariate logistic regression analysis pre-procedural AF and BivP were the only independent predictors of primary endpoint (HR 8.949, 95% CI 2.429 – 32.972, p = 0.001; HR 0.719, 95% CI 0.526 – 0.982, p=0.038, respectively). Kaplan-Meier curves showed that event survival free was higher in SR patients when compared to AF (69 ± 4 vs 24 ± 3 months, p<0.001).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">CONCLUSION: </span></span></span><span style="font-size:12.0pt"><span style="font-family:"Calibri Light",sans-serif">Pre<span style="background-color:white"><span style="color:black">-procedural AF and BivP are independent predictors </span></span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">of the occurrence of a primary endpoint of hospitalization due to HF or death for any cause in HF patients submitted to CRT.</span></span></span></span></span></span></p>
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