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Lower rate limit in cardiac resynchronization therapy–defibrillators: is lower better?
Session:
Posters (Sessão 3 - Écran 3) - Arrítmias 4 - Vários
Speaker:
M. Inês Barradas
Congress:
CPC 2022
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
m. Inês Barradas; Fabiana Duarte; Luís Resendes de Oliveira; Cátia Serena; António Xavier Fontes; André Viveiros Monteiro; Carina Machado; Raquel Dourado; Emília Santos; Nuno Pelicano; Miguel Pacheco; Anabela Tavares; Dinis Martins
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri"><span style="color:#000000">Background: There is few data about programmed lower rate limit (LRL) in real world heart failure (HF) patients with cardiac resynchronization therapy–defibrillators (CRT-Ds) and its influence in clinical outcomes. Heart rate score (HRS) is the percentage of all atrial-paced and sensed events in the single tallest 10 beats/min device histogram bin and may indicate impaired heart rate variability.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri"><span style="color:#000000">Purpose: We hypothesized that higher LRL programming is associated with worse clinical outcomes as arrhythmic events and HF decompensations in chronic HF patients with CRT-Ds.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri"><span style="color:#000000">Methods: LRL was evaluated and HRS was calculated from remote monitoring in 126 HF patients with CRT-D. Primary outcome was defined as HF hospitalizations and related admissions to the emergency department and secondary outcome as number of device therapies, sustained ventricular tachycardia (VT) and ventricular fibrillation (VF).</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri"><span style="color:#000000">Results: Mean age was 69,03 ± 10,39 years, 81 (64,3%) were males and mean follow-up was 53,72 ± 46,13 months. Mean left ventricular ejection fraction was 30,31 ± 8,33% and 29 (23,0%) were in NYHA III-IV. HF aetiology was idiopathic in 39 (43,3%), ischemic in 32 (25,4%) and alcoholic cardiomyopathy in 8 (6,3%). Thirty-seven (29,4%) patients had atrial fibrillation and 33 (26,2%) coronary disease. LRL ranged from to 40 to 80 bpm and mean LRL was 52,64 ± 9,64 and mean HRS 49,60 ± 23,17%. Programmed LRL was higher in women (p=0,014), patients with atrial fibrillation (AF) (p=0,012) and coronary disease (p=0,015). Higher LRL correlated with HF hospitalizations and related admissions to the emergency department (ED) (r=0,541, p=0,001), VT or VF episodes (r=0,337, p=0,005) and CRT-D number of therapies (r=0,342, p=0,004) and higher HRS (r=0,547, p<0,05). </span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri"><span style="color:#000000">Conclusion: Higher LRL programming was associated with higher HRS, HF decompensations with hospitalization or admission to the emergency department, VT or VF episodes and CRT-D therapies in a real world population. More studies are required but lower LRL may be preferred in HF patients.</span></span></span></p>
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