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Current use of CRT in patients with atrial fibrillation - Data from the ESC/EHRA/HFA Survey II

Session Moderated ePosters 7: contemporary cardiac resynchronization therapy: is there room for improvement?

Speaker Christoph Stellbrink

Congress : EHRA 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Cardiac Resynchronization Therapy
  • Session type : Moderated Posters
  • FP Number : 682

Authors : C Stellbrink (Bielefeld,DE), C Linde (Stockholm,SE), K Dickstein (Stavanger,NO), C Normand (Stavanger,NO), N Bogale (Stavanger,NO), M Gasparini (Milan,IT), C Sticherling (Basel,CH), M Gwechenberger (Vienna,AT), M Sterlinski (Warsaw,PL), C Blomstroem-Lundqvist (Uppsala,SE), R Sheahan (Cork,IE), G Filippatos (Athens,GR)

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Authors:
C Stellbrink1 , C Linde2 , K Dickstein3 , C Normand3 , N Bogale3 , M Gasparini4 , C Sticherling5 , M Gwechenberger6 , M Sterlinski7 , C Blomstroem-Lundqvist8 , R Sheahan9 , G Filippatos10 , 1Bielefeld Hospital - Bielefeld - Germany , 2Karolinska Institute - Stockholm - Sweden , 3Stavanger University Hospital - Stavanger - Norway , 4UOS of Milan and Humanitas Clinical and Research Center - Milan - Italy , 5University Hospital Basel - Basel - Switzerland , 6Medical University of Vienna - Vienna - Austria , 7Szpital Ibis - Warsaw - Poland , 8Uppsala University - Uppsala - Sweden , 9University College Cork - Cork - Ireland , 10University of Athens - Athens - Greece ,

On behalf: ESC/EHRA/HFA CRT Survey II

Citation:

Background: Patients (pts) with atrial fibrillation (AF) have been underrepresented in CRT trials although 25% of pts receiving CRT have AF. The ESC/EHRA/HFA CRT Survey II collected data on current CRT implant practice in 42 European countries. This analysis focuses on CRT implants with regard to AF presence. Methods and Results: Between October 2015 and January 2017, 11.088 pts with an initial implant or upgrade were included. Of 10843 pts with available data on AF presence, 4582 (42.2%) had AF; 1889 (42.4% of all AF) had permanent AF, 994 (22.3%) persistent AF and 1548 (34.7%) paroxysmal AF. AF pts. were older, had more advanced HF stage and more co-morbidities. AF pts were more often pacemaker (PM)-dependent, more often had a primary PM indication with a high expected % ventricular pacing and received fewer CRT devices with defibrillating capability (CRT-D). Perioperative complications were not increased in AF (5.2 vs. 5.8%, p=n.s.) although bleeding occurred more often (1.3 vs. 0.8%, p=0.002). Adverse events until discharge were more frequent in AF pts (5.4 vs. 4.3%, p=0.01), mostly due to increased infections, worsening renal function and arrhythmias, but did not more often necessitate re-intervention (4.0 vs. 4.1%). Conclusion: More pts suffering from AF receive a CRT implant than previously reported. AF pts are older and have more co-morbidities than pts without AF. Assuming a worse prognosis for AF pos, more prospective data on these pts is needed.

AF

no AF

p

age (yrs)+SD

71.0+9.8

66.7+11.2

<0.00001

% COPD

13.0

11.2

0.005

% CKD

39.3

25.3

<0.00001

% hospitalized for HF in 1 yr

50.7

43.6

<0.00001

% PM dependent

18.9

10.5

<0.00001

% NYHA III/IV

66.1

53.8

<0.00001

Indication: HF with wide QRS (%)

55.0

64.0

Indication: Primary ICD indication (HF) (%)

43.7

50.6

<0.00001

Indication: PM with high ventr. pacing(%)

31.8

16.6

Device type % CRT-D

63.1

74.4

<0.00001

% discharged alive

99.3

99.8

% progressive HF (of all deaths)

46.7

28.6

0.0005

(CKD = chronic kidney disease; COPD= chronic obstructive pulmonary disease; HD = heart disease)

The free consultation period for this content is over.

It is now only available year-round to EHRA Ivory (& above) Members, Fellows of the ESC and Young combined Members



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