SPC365

Predictive factors of mortality or clinical deterioration in atrial fibrillation patients receiving cardiac resynchronization therapy

Session: Posters (Sessão 3 - Écran 1) - Resincronização cardíaca
Speaker: João Grade Santos

Congress: CPC 2023
Topic: C. Arrhythmias and Device Therapy
Theme: 09. Device Therapy
Subtheme: 09.3 Cardiac Resynchronization Therapy
Session Type: Pósters Electrónicos
FP Number: ---
Authors: João Grade Santos; Bárbara Ferreira; Mariana Martinho; Diogo Cunha; João da Luz; Nazar Ilchyshyn; Oliveira Baltasar; Daniel Sebaiti; Khrystyna Budzak; João Simões; Rita Miranda; Sofia Almeida; Luís Brandão; Hélder Pereira

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:#222222">Introduction:</span></span></strong><span style="background-color:white"><span style="color:#222222">&nbsp;Cardiac resynchronization therapy (CRT) in heart failure patients with reduced ejection fraction (HFrEF) and wide QRS complexes has been shown to improve both functional capacity and quality of life, and to decrease hospital admissions and mortality. However, data on the benefit in patients with Atrial Fibrillation (AF) is scarce and recommendations by the ESC guidelines are only class IIA, limited to very symptomatic patients (New York Heart Association (NYHA) Class above III).</span></span></span></span></span></p>

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:#222222">Purpose:</span></span></strong><span style="background-color:white"><span style="color:#222222">&nbsp;Our aim was to assess predictors of a composite outcome of </span></span><span style="color:black">admissions for heart failure or cardiovascular death at 5 years</span><span style="background-color:white"><span style="color:#222222"> in patients with AF submitted to CRT implantation.</span></span></span></span></span></p>

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:#222222">Methods</span></span></strong><span style="background-color:white"><span style="color:#222222">:&nbsp;We performed a retrospective analysis between February 2010 and October 2022 of all patients with AF admitted for CRT implantation due to HFrEF with EF &lt;35% and QRS &gt;130ms in</span></span><span style="background-color:white"><span style="color:black"> a </span></span><span style="background-color:white"><span style="color:#222222">single expert centre. Medical records were analysed for demographics, clinical data and outcomes.&nbsp;</span></span></span></span></span></p>

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:#222222">Results</span></span></strong><span style="background-color:white"><span style="color:#222222">: Of the 209 patients assessed, 72 patients fulfilled all inclusion criteria. The mean age at implantation was 72,8</span></span><span style="color:black">&plusmn;10 years with a male preponderance (75%). </span></span></span></span></p>

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="color:black">Regarding the AF status, 58,3% were in paroxysmal AF and 41,7% in permanent AF.</span></span></span></span></p>

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="color:black">After implantation, 79% were considered as having adequate biventricular (BIV) pacing (above 90%) and 66% of patients were considered responders (NYHA improvement of at least 1 class and/or increase in 10% in EF).</span></span></span></span></p>

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="color:black">Adequate BIV pacing was significantly associated with response status (p&lt; 0,05).</span></span></span></span></p>

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="color:black">A primary composite end-point occurred in 17 (25,4%) of patients.</span></span></span></span></p>

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="color:black">The patient characteristics associated with an event were a prior of chronic kidney disease (OR 3,8; CI 95% 1,2-12,5, p&lt;0,05), an ischemic etiology (OR 3,3; CI 95% 1,1-11,1, p&lt;0,05) a non-responder status (OR 0,3; CI 95% 0,1-0,9 p&lt;0,05), an inadequate BIV pacing (OR 0,2; CI 95% 0,1-0,8, p&lt;0,05), elevated post implantation NT-proBNP level (OR 1,0; CI 1,0-1,1 95%, p&lt;0,05), higher post implantation NYHA status level (OR 3,2; CI 95% 1,3-7,9, p&lt;0,05), lower post implantation EF (OR 0,9; CI 95% 0,8-0,9, p&lt;0,05) and the lower magnitude of EF improval (OR 0,9; CI 95% 0,8-0,9, p&lt;0,05). The age, sex, pre implant NYHA class, type of AF, and type of CRT (with or without defibrillator capacity) were non-significant. </span></span></span></span></p>

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="color:black">Through a method of logistic regression, the best predictive model was composed of ischemic etiology, the post implantation NYHA status and magnitude of EF improval with a high predictive power for the occurrence of an event (OR 314,7; CI 95% 15,3 - 6452 p&lt;0,05; r2 0,49) and a high discriminative capacity, with the ROC curve analysis (figure 1) demonstrating an AUC of 0,90.</span></span></span></span></p>

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:#222222">Conclusions</span></span></strong><span style="background-color:white"><span style="color:#222222">:&nbsp;In this patient population, several independent predictors were identified, such as inadequate biventricular pacing and non-responder status, but a model composed of etiology, post implant NYHA status and magnitude of EF improval wielded the best predictive model.</span></span></span></span></span></p>