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Predictors in prevention of atrial fibrillation recurrence after elective electrical cardioversion
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; Pedro Azevedo; Daniela Carvalho; 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 in restoring sinus rhythm (SR) in patients with atrial fibrillation (AF). Besides that, recurrence rate is high, in up to 67% of patients within 4 weeks. <span style="font-size:10.0pt"><span style="font-family:"Segoe UI",sans-serif"><span style="color:black">Antiarrhythmics are used to prevent recurrence of AF after successful ECV, although </span></span></span>efficacy in maintenance of SR is modest. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><strong>Objectives: </strong><span style="color:black">Our aim is to identify clinical factors associated with early AF recurrence after successful ECV. More specifically, we aim to evaluate if treatment with beta-blockers and antiarrhythmics prevent AF recurrence.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><strong>Methods:</strong> <span style="color:black">Retrospective study between 2011-2020 of consecutive patients who underwent a successful ECV for AF in a Cardiology department. The outcome of interest was AF recurrence during follow-up, documented on a 12-lead ECG or Holter monitoring. The association between patient clinical characteristics and the outcome was assessed using the chi-square, student T-test or Wilcoxon rank sum test, as appropriate</span>. Multivariate analysis was performed using logistic and cox 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 235 patients were identified, with a mean age of 63.5±10.4 years, 71% male. 98.7% showed persistent AF, a mean weight of 80±15 Kg, 38% with obesity, 58% with hypertension, 26% with diabetes and 21% with heart failure. Antiarrhythmic pos-treatment and beta-blockers were administered in 90% and 53% of patients, respectively. <span style="color:black">Patients were followed for a mean of 49</span>±25<span style="color:black"> months. </span>64.3% of <span style="color:black">patients had an AF recurrence and the mean time until recurrence was 14 months.</span> Factors associated with no recurrence were diabetes (p=0.016), beta-blockers (p=0.046) and effective shock energy (p<0.013). Independent predictors in preventing recurrence were the use of beta-blockers (p=0.042, OR 0.54, 95% CI 0.29 to 0.98), and effective shock energy (p<0.003). Antiarrhythmic drugs (class I and III) were not associated with recurrence prevention (p=0.968, OR 0.98, 95% CI 0.34 to 2.78). Despite this, neither beta-blockers (p=0.899, HR 1.03, 95% CI 0.71 to 1.50) nor antiarrhythmics (p=0.394, HR 0.77, 95% CI 0.39- to 1.44) reduce time-to-recurrence. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><strong>Conclusion: </strong>Beta-blockers pos-treatment is an independent predictor in prevention of AF recurrence after a successful ECV, but without influence in the time-to-recurrence events. Antiarrhythmic drugs (class I and III) were not associated with prevention of recurrence.</span></span></p>
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