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Impact of Atrial Fibrillation on Mortality and Response to Cardiac Resynchronization Therapy in Heart Failure: A Retrospective Analysis
Session:
Sessão de Posters 30 - Terapia de Ressincronização Cardíaca
Speaker:
Joana Laranjeira Correia
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.6 Device Therapy - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Joana Laranjeira Correia; Vanda Devesa Neto; Gonçalo RM Ferreira; João Gouveia Fiuza; Mariana Duarte Almeida; Oliver Correia Kungel; Francisco Rodrigues Dos Santos; António Costa
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Introduction: Cardiac resynchronization therapy (CRT) is an established treatment for selected patients with heart failure (HF) and a wide QRS complex. HF is frequently complicated by atrial fibrillation (AF), which is associated with worsened outcomes. The presence of AF may interfere with optimal delivery of CRT due to competition with biventricular capture by conducted beats. Nevertheless, the effectiveness of CRT in patients with AF remains controversial. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Aims: The aim of the study was to analyze CRT results in patients with permanent AF. The endpoints analyzed were all-cause mortality in 24 months and response to CRT.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: A single-center retrospective study was conducted, including all consecutive patients who underwent CRT implantation between 2012 and 2019. Follow-up started after CRT implantation and ended upon death or 24 months after study entry. The subjects were divided into two groups: Group A (with AF) and Group B (in sinus rhythm (SR)). Patients were followed for 2 years after implantation, and Kaplan-Meier survival curves were determined for each group to assess the predictive capacity for all-cause mortality in 24 months. The authors also analyzed the correlation between the presence of AF and the response to CRT (ejection fraction (EF) increase of at least 10% after CRT implantation). The statistical analysis was performed in SPSS. A p-value <0.05 was considered statistically significant.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: 102 patients were included in the study (74.5% male, mean age 68±10.46 years). The mortality in 24-month follow-up was 8.8%. The percentage of patients in NYHA (New York Heart Association) II, III and IV was, respectively, 46.1%, 51% and 2.9%. Inappropriate shocks occurred in 2.94% of patients, and 27.5% of patients had no response to CRT.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">All-cause mortality in 24 months was more likely in patients with AF compared to patients in SR (X2 4.985 (p=0.026)). The presence of AF was an independent predictor of the primary outcome (p=0.035; 95% IC 0.33-0.73) after adjusting for gender, diabetes mellitus, hypertension, dyslipidemia and smoking. However, the response to CRT was similar between both groups (x2 1.713; p= 0.191 – OR 0.559; 95% IC 0.232-1.343). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusion: The presence of AF is associated with increased likelihood of all-cause death. However, the response to CRT was not altered by the presence of AF. Randomized controlled trial are lacking to compare the response to CRT between patients with AF and patients in SR. Further randomized, large-scale studies are required to confirm our study results.</span></span></p>
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