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Bandarupalli T, Mandapati R, Shah K, Bharadwaj R, Contractor T, Lakkireddy D, Garg J. Adverse events associated with PentaRay Mapping Catheter – MAUDE database analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The 20 pole PentaRay Mapping Catheter is a high-definition mapping catheter with five soft, flexible spines providing better and faster acquisition. Despite its design, the catheter is not without glitches.
Objective
We queried the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database for adverse events related to the use of the PentaRay mapping catheter.
Methods
The Manufacturer and User Facility Device Experience (MAUDE) database was searched for reports received between October 1, 2019, to October 31, 2021, to capture all adverse events associated with PentaRay mapping catheter using the term “PentaRay” in the “brand name” section. The adverse events were adjudicated to various categories based on the review of the event description for each medical device report (MDR).
Results
A total of 159 events were reported in 148 MDRs during the study period. The most common device related issues were: damaged splines 18.2% (n=29), device entrapment 17% (n=27), thrombus on device 15.1% (n=24), foreign material on splines 8.8% (n=14), sensor error 3.8% (n=6). Of the patient related events, 13.8% (n=22) were pericardial effusion, 5% (n=8) cardiac arrest, 1.2% (n=2) coronary vasospasm/STEMI, 0.6% (n=1) heart block, 0.6% (n=1) air embolism, 0.6% (n=1) tear in pulmonary veins. These events lead to procedure abortion 27.7% (n=44) and procedural delay 11.3% (n=18).
Conclusion
Several issues have been reported with the PentaRay mapping catheter leading to to procedure abortion, delay and patients related adverse events. Understanding and troubleshooting may help improve patient outcomes.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Bandarupalli
- East Tennessee State University , Johnson City , United States of America
| | - R Mandapati
- Loma Linda University Medical Center, Clinical Electrophysiology , Loma Linda , United States of America
| | - K Shah
- William Beaumont Hospital, Clinical Electrophysiology , Royal Oak , United States of America
| | - R Bharadwaj
- Loma Linda University Medical Center, Clinical Electrophysiology , Loma Linda , United States of America
| | - T Contractor
- Loma Linda University Medical Center, Clinical Electrophysiology , Loma Linda , United States of America
| | - D Lakkireddy
- The Kansas City Heart Rhythm Institute at HCA Midwest Health, Clinical Electrophysiology , kansas city , United States of America
| | - J Garg
- Loma Linda University Medical Center, Clinical Electrophysiology , Loma Linda , United States of America
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Griffiths J, Liang J, Khairy P, Srivatsa UN, Frankel D, Sandhu A, Shoemaker MB, Natale A, Lakkireddy D, De Groot NMS, Gerstenfeld E, Moore JP, Avila P, Ernst S, Nguyen DT. Catheter ablation for atrial fibrillation in adult congenital heart disease: an international registry study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Life expectancies for patients with congenital heart disease (CHD) have dramatically increased in recent years, accompanied by a rise in atrial fibrillation (AF) prevalence. Data on AF ablation strategy and outcomes are limited in CHD.
Purpose
We aimed to investigate the characteristics of CHD patients presenting for AF ablation and their outcomes.
Methods
A multicenter, retrospective analysis was performed of CHD patients undergoing AF ablation between 2004 and 2020 at 13 participating centers. The severity of CHD was classified using the 2014 PACES/HRS guidelines. Clinical data were collected including ablation strategy and follow up. One-year procedural success was defined as freedom from AF in the absence of antiarrhythmic drugs (AADs, complete) or including previously failed AADs (partial).
Results
Of 240 patients, 127 (53.4%) had persistent AF, 62.5% were male, and mean age was 55.2±0.9 years. CHD complexity categories included 147 (61.3%) simple, 69 (28.8%) intermediate and 25 (10.4%) severe. The most common CHD type was atrial septal defect (n=78). More complex CHD conditions included transposition of the great arteries (n=14), anomalous pulmonary veins (n=13), tetralogy of Fallot (n=8), cor triatriatum (n=7), single ventricle physiology (n=2), among others. The majority (71.3%) of patients had AF despite at least one AAD. 46 patients (22.1%) had a reduced systemic ventricular ejection fraction <50%, and the mean left atrial diameter was 44.1±0.7 mm. PV isolation (PVI) was performed in 227 patients (94.6%); additional ablation strategies included left atrial linear ablations (25.4%), CFAE (19.2%), and cavotricuspid isthmus ablation (40.8). One-year complete and partial success rates were 45.0% and 20.5%, respectively, with no significant difference in the rate of complete success between complexity groups. Overall, 38 patients (15.8%) required more than one ablation procedure. There were 3 (1.3%) major and 13 (5.4%) minor procedural complications.
Conclusion
AF ablation in this complex population was safe and resulted in AF control in the majority of patients. Future work should address the most appropriate ablation targets in the challenging population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Griffiths
- Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust , London , United Kingdom
| | - J Liang
- University of Michigan , Ann Arbor , United States of America
| | - P Khairy
- Montreal Heart Institute , Montreal , Canada
| | - U N Srivatsa
- University of California-Davis , Sacramento , United States of America
| | - D Frankel
- University of Pennsylvania , Philadelphia , United States of America
| | - A Sandhu
- University of Colorado , Aurora , United States of America
| | - M B Shoemaker
- Vanderbilt University Medical Center , Nashville , United States of America
| | - A Natale
- Texas cardiac Arrhythmia , Austin , United States of America
| | - D Lakkireddy
- University of Kansas Medical Center , Kansas City , United States of America
| | - N M S De Groot
- Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - E Gerstenfeld
- University of California San Francisco , San Francisco , United States of America
| | - J P Moore
- University of California Los Angeles , Los Angeles , United States of America
| | - P Avila
- University of California Los Angeles , Los Angeles , United States of America
| | - S Ernst
- Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust , London , United Kingdom
| | - D T Nguyen
- Stanford University Medical Center , Stanford , United States of America
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3
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Magnocavallo M, Della Rocca D, Van Niekerk C, Gilhofer T, Ha G, D‘Ambrosio G, Galvin J, Urbanek L, Lavalle C, Schmidt B, Geller C, Lakkireddy D, Di Biase L, Price M, Mansour M, Saw J, Horton R, Gibson D, Natale A. P95 PERI–PROCEDURAL COMPLICATIONS AND LONG–TERM OUTCOMES IN ATRIAL FIBRILLATION PATIENTS STRATIFIED FOR CHRONIC KIDNEY DISEASE SEVERITY UNDERGOING LEFT ATRIAL APPENDAGE OCCLUSION: RESULTS FROM AN INTERNATIONAL, MULTICENTER REGISTRY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist and share an increased risk of thromboembolic events. CKD concomitantly contributes to several pathophysiological changes predisposing towards a pro–haemorrhagic state.
Objective
To evaluate the impact of kidney function on peri–procedural complications and clinical outcomes in AF patients undergoing left atrial appendage occlusion (LAAO) with a Watchman device.
Methods
2124 consecutive AF patients undergoing Watchman implantation at 8 different centers were categorized into CKD stage 1 + 2 (n = 1089), CKD stage 3 (n = 796), CKD stage 4 (n = 170), CKD stage 5 (n = 69) based on the estimated glomerular filtration rate at baseline. The primary efficacy endpoint included a composite of cardiovascular (CV) mortality, stroke, transient ischemic attack, peripheral thromboembolism (TE), and major bleeding.
Results
A non–significant higher incidence of major peri–procedural adverse events (1.7% vs. 2.3% vs. 4.1% vs. 4.3%) was observed with worsening baseline kidney function (p = 0.14). The mean follow–up period was 13 ± 7 months [2226 patient–years (PY)]. In comparison to CKD stage 1 + 2 as a reference, the incidence of the primary endpoint was significantly higher in CKD stage 3 (log–rank p–value= 0.04), CKD stage 4 (log–rank p–value= 0.01), and CKD stage 5 (log–rank p–value= 0.001) (Fig. 1A). A non–significant increase in event rates for stroke/TIA and clinically relevant bleeding was observed among the four groups. LAAO led to a TE risk reduction of 72%, 66%, 62%, and 41% in each group (Fig. 1B). The relative risk reduction in the incidence of major bleeding was 58%, 44%, 51%, and 52%, respectively (Fig. 1C).
Conclusion
Patients with moderate–to–severe CKD had a higher incidence of the primary composite endpoint. The relative risk reduction in the incidence of TE and major bleeding was consistent across CKD groups, irrespective of the very different risk profiles at baseline.
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Affiliation(s)
- M Magnocavallo
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - D Della Rocca
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - C Van Niekerk
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - T Gilhofer
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - G Ha
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - G D‘Ambrosio
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - J Galvin
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - L Urbanek
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - C Lavalle
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - B Schmidt
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - C Geller
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - D Lakkireddy
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - L Di Biase
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - M Price
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - M Mansour
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - J Saw
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - R Horton
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - D Gibson
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - A Natale
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
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4
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Saksena S, Slee APRIL, Lakkireddy D, Shah DIPEN, Di Biase LUIGI, Lewalter T, Natale A. Factors predicting adverse cardiovascular outcomes in patients with atrial fibrillation and heart failure with preserved ejection fraction. Europace 2021. [DOI: 10.1093/europace/euab116.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Electrophysiology Research Foundation
Introduction
Atrial fibrillation (AF) is known to impact cardiovascular(CV) mortality in heart failure (HF) patients (pts) with preserved ejection fraction (pEF) but its exact causes are unknown.
Methods
We analyzed demographic, clinical, ECG and AF presentation as predictors of CV mortality, sudden death( SCD) and pump failure death(PFD) in HFpEF pts in the TOPCAT AMERICAS trial. We analyzed two AF presentations 1. Pts in sinus rhythm (SR, n = 1319) compared to AF on ECG (n = 446) at entry or 2. Pts with no AF event by history or ECG ( n = 1007 ) to those with any AF event (n = 760 ).
Results (Table): 5 year (yr) CV mortality was higher in pts with AF on ECG (30%) than SR (18%, p = 0.014) but 5 yr SCD was (10% in AF on ECG & 7% in any AF) & comparable to SR (7% & 9% respectively, p = ns). 5 yr PFD was higher in AF on ECG (13%) than SR (5%, p = 0.007)
Conclusions
: 1. CV death risk in HFpEF pts increased with AF on ECG.. 2. SCD was not more frequent with both AF presentations 3. PFD in HFpEF increased with age, ECG recorded AF & elevated heart rate. 4. The recording of AF on ECG was more strongly associated with CV death & PFD, possibly due to greater AF burden . Predictors of adverse outcomes in HFpEF AF on ECG* Any AF* Endpoint Covariate HR (95% CI) p-value HR (95% CI) p-value Time to cardiovascular death Atrial Fibrillation* 1.44 (1.08, 1.92) 0.014 1.15 (0.87, 1.51) 0.338 Age (years) 1.03 (1.02, 1.05) <.001 1.03 (1.02, 1.05) <.001 Black/AA (vs. White) 0.97 (0.65, 1.46) 0.002 0.96 (0.64, 1.44) 0.004 Other race (vs. White) 2.41 (1.46, 3.99) 2.32 (1.41, 3.83) Smoking 2.62 (1.63, 4.20) <.001 2.60 (1.62, 4.17) <.001 Diabetes 1.47 (1.12, 1.94) 0.006 1.45 (1.10, 1.91) 0.009 Systolic BP (mmHg) 0.99 (0.98, 1.00) 0.022 0.99 (0.98, 1.00) 0.014 Heart rate (bpm) 1.02 (1.00, 1.03) 0.012 1.02 (1.01, 1.03) 0.006 Time to Any sudden cardiac death Atrial Fibrillation* 1.17 (0.69, 1.96) 0.563 0.85 (0.53, 1.35) 0.484 Female (vs. Male) 0.46 (0.28, 0.75) 0.002 0.46 (0.28, 0.74) 0.002 Black/AA (vs. White) 1.57 (0.87, 2.82) 0.194 1.49 (0.83, 2.69) <.001 Other race (vs. White) 1.76 (0.70, 4.41) 1.70 (0.68, 4.25) Diabetes 1.70 (1.07, 2.70) 0.024 1.65 (1.04, 2.62) 0.033 Time to pump failure death Atrial Fibrillation* 2.04 (1.22, 3.42) 0.007 1.62 (0.96, 2.75) 0.074 Age (years) 1.06 (1.03, 1.10) <.001 1.06 (1.03, 1.10) <.001 Heart rate (bpm) 1.03 (1.00, 1.05) 0.034 1.03 (1.01, 1.05) 0.015 Cox model of covariates associated with outcomes adjusted for baseline imbalances
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Affiliation(s)
- S Saksena
- Electrophysiology Research Foundation, Warren, NJ, United States of America
| | - APRIL Slee
- Electrophysiology Research Foundation, Warren, NJ, United States of America
| | - D Lakkireddy
- Kansas City Heart Rhythm INstitute, Cardiology, Kansas City, United States of America
| | - DIPEN Shah
- Hopitaux Universitaires De Geneve, Geneva, Switzerland
| | - LUIGI Di Biase
- Montefiore Medical Center, Cardiology, Bronx NY, United States of America
| | - T Lewalter
- Internal Medicine Clinic München South, Cardiology, Munich, Germany
| | - A Natale
- St. David"s Medical Center, Austin, United States of America
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