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Echocardiographic factors in short term recurrence after atrial fibrillation ablation
Session:
Sessão de Posters 13 - Ablação de fibrilhação auricular
Speaker:
João Mirinha Luz
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
João Mirinha Luz; Luís Brandão; Rita Miranda; Sofia Almeida; Alexandra Briosa; João Grade Santos; Diogo Santos da Cunha; Oliveira Baltazar; Nazar Ilchyshyn; Liliana Brochado; Hélder Pereira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Introduction and objectives:</u></strong> Rate control in atrial fibrillation (AF) is the mainstay of management with recent studies showing association with lower mortality and better quality of life. Pulmonary vein isolation (PVI) is becoming a cornerstone for rhythm control in AF, with high rates of success. Echocardiography is a paramount exam when assessing patients with AF, so we aimed to evaluate possible factors for short term recurrence after PVI.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Methods:</u></strong> We performed a retrospective analysis of one-hundred and sixty patients subjected to PVI between January 2013 and June 2023. We excluded seventy-three patients from our analysis due to lack of echocardiograpic data. Left atrial area (LAA), volume (LAV), body-surface-area indexed volume (I-LAV), diameter, mitral inflow E and A waves, annular e’ velocities, E/e’ ratio (global, lateral and septal), deceleration time of E wave and tricuspid regurgitation velocity were assessed, also to evaluate presence of diastolic disfunction. AF recurrence at three (3), six (6) and twelve (12) months after PVI were defined as primary outcomes.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Results:</u></strong> Mean age at time of PVI was 60,05 years-old (SD 10,09). Paroxysmal AF was the main reason for PVI (75%). Presence of diastolic disfunction, LAA, LAV and I-LAV were associated with AF recurrence (table 1), with LAA and LAV being the only factors that were consistent at 3, 6 and 12 month-rate recurrences. Using Cox uni- and multivariate analysis, LAA was the only factor independently associated with recurrence at 6 [hazard ratio (HR) 1.27, 95% confidence interval (CI) 1.05-1.54, p=0.014] and 12 months (HR 1.21, 95% CI 1.04-1.40, p<0.001), regardless of sex, age and presence of comorbidities. Using ROC analysis, patients with LAA above 25.50cm2 [at 3 months: area under the curve (AUC)=0.771, sensitivity (S)=83.3%, specificity (E)=74.3%, p = 0.036; at 6 months: AUC=0.887, S=90%, E=83.9%, p<0.001] and 22.94cm2 (at 12 months: AUC=0.838, S=85.7%, E=73.9%, p<0.001) were at higher risk of AF recurrence.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Conclusion:</u></strong> Our analysis showed that various parameters measured by echocardiography could be associated with short term (up to 1 year) AF recurrence. LAA was independently associated with AF recurrence regardless of sex, age, and comorbidities. Patients with overt diastolic dysfunction should be closely followed after PVI, and should probably require more aggressive antiarrhythmic regimens to maintain sinus rhythm after structural rhythm control.</span></span></p>
Slides
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