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Cardiac resynchronization therapy in atrial fibrillation: response and long-term outcomes
Session:
Comunicações Orais (Sessão 12) - Insuficiência Cardíaca 2 - Tratamento
Speaker:
Mariana Silva Brandão
Congress:
CPC 2022
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Mariana s. Brandão; João Gonçalves Almeida; Paulo Fonseca; Elisabeth Santos; Filipa Rosas; José Nogueira Ribeiro; Marco Oliveira; Helena Gonçalves; João Primo; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>BACKGROUND</strong>: Patients (pts) with atrial fibrillation (AF) were excluded from major resynchronization therapy (CRT) trials. Studies suggest AF pts derive less benefit from CRT.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>AIM:</strong> To compare response and clinical outcomes after CRT in pts in AF or in sinus rhythm (SR).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>METHODS:</strong> Single-center retrospective study of consecutive pts submitted to CRT implantation (2007-2018). Major adverse cardiac events (MACE) included heart failure (HF) hospitalization or all-cause mortality (ACM). Clinical response was defined as NYHA class improvement without MACE in the 1<sup>st</sup> year of follow-up (FU). Left ventricle end-systolic volume reduction of >15% at 1-year defined echocardiographic (echo) response. Survival analysis with Kaplan-Meier method and <em>Log-rank</em> test was performed. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>RESULTS:</strong> 295 CRT pts (70.5% male, 68±16 years, 54.6% CRT-D) were included. 95 (32.6%) pts presented in AF; these were older (72 <em>vs </em>67, p=.007), with higher prevalence of coronary disease (40.2% <em>vs </em>24.2%, p=.008), significant tricuspid regurgitation (21.7% <em>vs </em>8.8%, p=.011) and kidney disease (33.0% <em>vs</em> 16.5%, p=.003). AF pts had larger left atrial diameters (50.5 <em>vs</em> 44.6 mm, p<.001) and higher baseline N-terminal pro B-type natriuretic peptide values (6738.6 <em>vs</em> 3179.4 pg/ml, p=.044). HF etiology (p=.242) and type of device (p=.127) did not differ. Secondary prevention indications for CRT-D were more common in AF pts (45.0% <em>vs </em>15.7%, p<.001). Atrioventricular junction ablation was performed in 14.0% of AF pts. Median percentage of biventricular pacing (BiVp) was significantly lower in AF pts (97 <em>vs </em>99, p<.001). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">NYHA class improvement (79.3% <em>vs </em>78.9%, p=.930) and echo response (65.4% <em>vs </em>75.2%, p=.269) were similar between AF and SR pts. Clinical response was lower in AF pts (52.7% <em>vs </em>66.5%, p=.036). During a median FU of 3±5 years, occurrence of MACE (<em>Log-rank</em> test, p<.001) and all-cause mortality (<em>Log-rank</em> test, p=0.011) were higher in AF. Among pts achieving BiVp≥98% (67.8%), clinical response did not differ between AF and SR pts (68.4% <em>vs</em> 70.5%, p=.968). Mortality was also similar between groups (<em>Log-rank</em> test, p=.214). MACE remained more frequent in AF group (<em>Log-rank</em> test, p=.029).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>CONCLUSIONS: </strong>In this cohort, despite having a higher comorbidity burden, AF pts showed similar NYHA class improvement and echo response to SR pts. Among pts with BiVp ≥98%, clinical response and all-cause mortality were also comparable between groups. Strategies to optimize response and outcomes in AF pts are warranted.</span></span></p>
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