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Antiarrhythmic pre-treatment as a predictor of successful elective electrical cardioversion of atrial fibrillation
Session:
Posters (Sessão 5 - Écran 1) - Fibrilhação auricular - clínica
Speaker:
Hugo Costa
Congress:
CPC 2023
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.8 Atrial Fibrillation - Clinical
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Hugo Alex Costa; Miguel Espirito Santo; Raquel Fernandes; Daniela Carvalho; Pedro Azevedo; Rui Candeias; Jorge Mimoso; Ilidio Jesus
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><strong>Introduction: </strong>Electrical cardioversion (ECV) remains the most cost-effective and safest method for acute restoration of sinus rhythm (SR) in patients with atrial fibrillation (AF), although at least 25% of ECV are unsuccessful. Antiarrhythmic pretreatment may increase ECV success rate (recommendation IIa/B in European guidelines) but use in clinical practice is not entirely consensual. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><strong>Objectives: </strong>Characterize a modern population of patients with AF submitted to ECV and identify factors associated with increased rate of acute success of ECV for AF. Additionally, we specifically aimed to evaluate the role of antiarrhythmic pretreatment, as well as the type of patients who benefit the most. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><strong>Methods:</strong> Retrospective study between 2011/2020, composed of n=349 patients undergoing ECV of AF. Patients were divided in two groups (successful and unsuccessful). <span style="color:black">Acute success in ECV was defined as restoration of sinus rhythm after the first shock.</span> Categorical variables are presented as frequencies and percentages, and continuous variables as means and standard deviations, or medians and interquartile ranges for variables with skewed distribution or a significant Shapiro-Wilk test. <span style="color:black">Comparison between groups were performed using the chi-square, student T-test or Mann Whitney, as appropriate.</span> Multivariate analysis was performed using logistic regression. P value < 0.05 indicates statistical significance.</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 349 patients were identified, with a mean age of 65±11 years, 67% male. 97.7% showed persistent AF, a mean weight of 80±15 Kg, 40% with obesity, 60% with hypertension, 22% with diabetes and 19% with heart failure. Antiarrhythmic pre-treatment and beta-blockers were administered in 58% and 54% of patients, respectively. Factors associated to successful group were age (p=0.013), weight (p=0.047), beta-blockers (p=0.047), AF burden (p=0.020) and effective shock energy (p<0,001). Independent predictors of successful ECV were antiarrhythmic pre-treatment, increasing success in 2.5 times (p=0.045, OR 2.46, 95% CI 1.02 to 5.93), and effective shock energy (p<0.001). There were no differences between the antiarrhythmic drugs (p=0.482), nor a reduction in shock energy in this group (p=0.217). In a subgroup analysis, patients with AF burden > 12 months showed greater benefit with antiarrhythmic pre-treatment (p=0.008) with amiodarone (p=0.028). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><strong>Conclusion: </strong>Antiarrhythmic pre-treatment is an independent predictor of successful ECV at first shock, mainly in patients with a higher AF burden (> 12 months).</span></span></p>
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