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Prognostic impact of maximal nocturnal heart rate in heart failure patients with an implantable electronic device.
Session:
Sessão de Posters 16 - Arritmologia
Speaker:
Fabiana Duarte
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
04. Arrhythmias, General
Subtheme:
04.6 Arrhythmias, General – Clinical
Session Type:
Cartazes
FP Number:
---
Authors:
Fabiana Silva Duarte; Inês Santos; Maria Inês Barradas; Luís Oliveira; Sónia Oliveira; André Monteiro; Carina Machado; Raquel Dourado; Emília Santos; Nuno Pelicano; Anabela Tavares; Dinis Martins
Abstract
<p>Introduction: Resting heart rate and daily heart rate variability are recognized markers of cardiac adverse events in heart failure patients. Nocturnal heart rate is also a relevant marker of cardiac autonomic function, but its prognostic impact on arrhythmic episodes and cardiac adverse events remains a subject of research.</p> <p>Objective: Investigate clinical significance of maximal nocturnal heart rate (mnHR) in a cohort of heart failure (HF) patients with remote monitoring electronic devices.</p> <p>Methods: Single-center retrospective study including 68 HF patients with implantable devices (ICD or CRT-D) over a 5-year follow-up, focusing on life-threatening arrhythmias and HF hospitalizations.</p> <p>Results: The mean age was 63.12±12.07 years, and 82.3% were males. HF etiology was idiopathic in 25,0% and ischemic in 23,5%. Regarding comorbidities, 36,7% had hypertension, 41,2% had dyslipidemia, 42,6% were overweight or obese and 4,4% had sleep apnea. In relation to implantable electronic devices, 47,0% had an ICD and 52,9% had a CRT-D. In our cohort, mnHR was < 80 beats/minute in 46 (67,6%) patients (Group 1) and ≥ 80 beats/minute in 22 (32,3%) (Group 2). Group 1 patients had more frequent type 2 diabetes (p=0.025). No other differences in baseline characteristics were detected between groups.<br /> Regarding outcomes, 14 (20,6%) patients experienced HF hospitalization during follow-up. Eight (11.8%) patients suffered at least one episode of monomorphic ventricular tachycardia, and 7 (10.3%) experienced ventricular fibrillation. Ventricular fibrillation episodes were more prevalent in Group 2 (HR 1.2, 95% CI 0.66 – 6.1, p=0.011). The number of hospital admissions was also higher in Group 2 (HR 2, 95% CI 0.52 – 4.1, p=0.009). Additionally, the number of atrial fibrillation episodes was higher in Group 2 (p=0.021), but without correlation with embolic events (p=0.08). No baseline characteristics independently predicted any of the reported adverse events (p=0.89).</p> <p>Conclusion: In remotely monitored patients with an implantable electronic device, the occurrence of a higher nocturnal heart rate was correlated with a higher rate of arrhythmic events and HF hospital admissions. Despite the limitations of a reduced number of patients included in our cohort and the lower incidence of adverse events, our analysis supports the impact of higher nocturnal heart rates on cardiac adverse events.</p>
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