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Atrial fibrillation and Cardiac resynchronization therapy – is this combination truly bad?
Session:
Painel 5 - Arritmologia 8
Speaker:
Pedro Silvério António
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Posters
FP Number:
---
Authors:
Pedro Silvério António; Afonso Nunes Ferreira; Inês Aguiar Ricardo; João Pedro Ribeiro Agostinho; Tiago Graça Rodrigues; Rafael Santos; Nelson P. Cunha; Sara Couto Pereira; Pedro Morais; Joana Brito; Andreia Magalhães; Ana Bernardes; Fausto José Pinto; João Rodrigues De Sousa; Pedro Nuno Carlos Marques
Abstract
<p>Introduction:<br /> Cardiac resynchronization therapy (CRT) significantly reduces mortality and hospitalizations in patients with heart failure and reduced ejection fraction (EF). Atrial fibrillation (AF) is a very common comorbidity in these patients, however, CRT benefit in AF patients has been controversial.</p> <p>Purpose:<br /> To compare the prognostic impact of CRT in patients (pts) with and without AF.</p> <p>Methods:<br /> Prospective, single-center study that included pts undergoing CRT implant since 2015. Clinical and echocardiographic evaluation were made before CRT implant and between 6-12 months post-implant. Pts with EF elevation ≥10% or LV end-systolic volume (ESV) reduction ≥15% were classified as responders. Patients with EF elevation ≥ 20% or ESV reduction ≥30% were classified as super-responders. All the parameters were compared between patients with and without AF. Prognostic impact of CRT was evaluated by comparing total mortality using the Cox regression and Kaplan-Meier methods.</p> <p>Results:<br /> From 2015-2019, 566 CRTs were implanted (26.1% female, 72±10.2 years old, follow-up duration 18.9±15.8 months). From these patients, 166 patients (31%) had AF (73.5% males, mean age 72.2±10.2 years, 37.3% ischemic, LVEF < 30% in 65.5%). The cardiovascular risk factors and comorbidities were similar in both populations (with and without AF), except for chronic kidney disease which was more frequent in AF pts (28% vs 17%, p=0.012).<br /> The prevalence of complications and surgical revision were similar in both groups.<br /> The CRT response rate was similar in both groups (50% in AF group vs 59.6%, p=NS) as was the super-response rate (22.4% in FA pts vs 31.5%, p=NS).<br /> The 4-year survival rate of patients with AF was similar to non-AF (83.7% vs 84.3%).</p> <p>Conclusion:<br /> Despite the controversy about the efficacy of CRT in AF pts, in our population the long-term survival and CRT response rates were comparable between patients with and without AF.</p>
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