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01. History of Cardiology
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05. Atrial Fibrillation
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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The impact of atrial fibrillation in cardiac resynchronisation therapy
Session:
SESSÃO DE POSTERS 48 - RESSINCRONIZAÇÃO CARDÍACA E CDI
Speaker:
André Paulo Ferreira
Congress:
CPC 2025
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Cartazes
FP Number:
---
Authors:
André Paulo Ferreira; Ana Raquel Santos; Sofia Jacinto; Hélder Santos; Bruno Valente; Guilherme Portugal; Ana Lousinha; Pedro Silva Cunha; Rui Cruz Ferreira; Mário Oliveira
Abstract
<p><strong>Background</strong>: Cardiac resynchronisation therapy (CRT) can be a very impactful intervention in patients with heart failure with reduced ejection fraction (HFrEF) and ventricular desynchrony. However, the presence of atrial fibrillation (AF) may attenuate CRT rates of response due to a combination of reduced biventricular pacing and loss of atrioventricular synchrony.<br /> <br /> <strong>Purpose</strong>: To investigate the impact of AF on CRT-induced reverse remodelling and functional capacity improvements.<br /> <br /> <strong>Methods</strong>: A single-centre retrospective study of patients with HFrEF and a wide QRS complex who underwent CRT implantation between 2015 and 2022. CRT responders were defined as those exhibiting an absolute >5% improvement in LVEF at 6 months of follow-up. CRT response was compared between patients with AF or sinus rhythm.<br /> <br /> <strong>Results</strong>: A total of 166 patients were included in this study. Patient's mean age was 70.3±10.5 years, and 73.0% were male. Of the total patients, 33.8% had ischemic heart disease and 66.2% dilated cardiomyopathy, 72.7% had left bundle branch block, and the median New York Heart Association functional class was 2 (IQ 2-3). Before CRT implantation, the mean LVEF was 26.2±6.9%, and 44.6% of patients had AF. Of the latter, 43.2% had paroxysmal AF and 56.8% had persistent AF. At 6 months of follow-up after CRT implantation, we found that patients with AF had a similar mean increase in LVEF compared sinus rhythm (SR) 11.7±4.5% vs 12.8±5.4% (p = 0.498), despite the presence of higher mean heart rates in the AF group, as suggested by the mean heart rates of 79.8±9.2 vs 71.4±8.4bpm (p = 0.039) at rest in the follow-up clinic visits. The improvement in LVEF did not differ significantly between the persistent vs paroxysmal AF subgroups 10.7±4.1% vs 11.9±5.5% (p = 0.644). The CRT response rate was consequently also similar in both AF and RS groups 71.4% vs 75.2% (p = 0.325). However, the improvement of ≥1 classes in NYHA classification was significantly lower in the AF group, 60.7% vs 75.1% (p < 0.01). There were no significant differences in mortality rates at 1 year of follow-up 3.4% vs 3.9% (p = 0.687).<br /> <br /> <strong>Conclusion</strong>: Patients with AF appear to show significant improvements and reverse remodelling effects after CRT implantation, similar to those of sinus rhythm patients, but smaller benefits are noted regarding functional outcomes.</p>
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