lo mejor en fa. - sociedad española de cardiología · lo mejor en fa. dr. ignacio fernández...
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Lo mejor en FA.
Dr. Ignacio Fernández Lozano.
Hospital Universitario Puerta de
Hierro, Majadahonda.
Registro RE-LY:
Variaciones en el manejo de la FA y la mortalidad.
End point No rheumatic heart disease
(n=13 507)
Rheumatic heart disease
(n=1788)
Stroke (%) 4 3
Age (y) 66.2 49.5
Female (%) 45.4 64.9
Hypertension (%) 60.3 19.6
Coronary disease (%) 34.3 5.5
Heart failure (%) 33 34.7
Warfarin use (%) 32 68.7
15.408 pacientes en 47 paises.
Mortalidad a 1 año 11%.
Africa 20%
Sur America 18%
Europa occidental 7,5%
Europa del este 8%
India 9% Jeff Healey
Primary endpoint
To describe the clinical epidemiology of
patients undergoing an AFib ablation
procedure, and the diagnostic /
therapeutic processes applied in these
patients across Europe.
1410 patients included
1300 patients at 12 months follow-up
1390 patients at discharge
1391 patients with ablation Procedure performed
1 death during the in-hospital phase
90 lost to Follow-up (6.5%)
19 patients without ablation
0
50
100
150
200
250
300
350
Centres In-Hospital Phase
Centres in 12-month Follow-up Phase
Patients In-Hospital Phase
Patients in 12-month Follow-up Phase
Atrial Fibrillation Ablation Pilot Registry
Follow-up status
88,1
7,6 1,2 1,4
1,7
Baseline rhythm at 12-month FU
Sinus rhyhtm
Atrial fibrillation
Common atrial flutter
Atypical atrial flutter
Pacemaker rhythm
Sinus rhythm Other rhythms P TOTAL
Heart rate (bpm)
mean ± SD
median (IQR)
68.7 ± 11.5
67 (60 – 67)
91.7 ± 26.2
90 (70 – 100)
<0.0001
71.4 ± 15.8
69 (61 – 79)
Atrial Fibrillation Ablation Pilot Registry
Follow-up status
Paroxysmal
AFib
(n = 856)
Non-paroxysmal
AFib
(n = 425)
p TOTAL
(n = 1281)
Overall Success, %
Without AADs, %*
With AADs, %*
75.6
59.8
40.2
69.0
49.1
50.9
0.015 73.7
56.5
43.5 * With respect to overall success.
Ablación FA:
Registro europeo.
1.300 pacientes en 10 paises europeos.
73,7% libres de recurrencia de arritmias en 1 año.
90% libres de síntomas.
65% tomaban ACO.
33% bajo tto antiarrítmico.
72,3
41,8 37,6
24,4
13,7 10,4
3,8 1,1
13,1
34,3
12,6 12,8
6,2 3,2 4,8
0,6 3,7
54,8
0
10
20
30
40
50
60
70
80
90
100
Palpitations Fatigue Dyspnea Weakness Dizziness / presyncope
Chest pain Syncope Other None
Baseline
12-month FU
87
0
10
55
63
1 2
24
54
1 1
28
0
10
20
30
40
50
60
70
80
90
100
Vitamin K antagonist
Dabigatran LMWH Antiplatets
At discharge
Before 12-month visit
After 12-month visit
Atrial Fibrillation Ablation Pilot Registry
Follow-up status
CHADS2-Vasc, %
0
1
>1
48.0
63.3
76.2
Anticoagulation at 12-m FU according to
cardioembolic risk
CHADS2, %
0
1
>1
53.1
69.0
81.6
12-month FU: 64.7% under anticoagulation
%
23
4
10
22
9
16
3
7
16
9
12
2
5
14
8
0
5
10
15
20
25
Amiodarone Dronadorone Propafenone Flecainide Other antiarrhythmic
At discharge
Atrial Fibrillation Ablation Pilot Registry
Follow-up status
12-month FU: 32.1% under AADs
%
Ablación FA:
Registro europeo.
1.300 pacientes en 10 paises europeos.
73,7% libres de recurrencia de arritmias en 1 año.
90% libres de síntomas.
65% tomaban ACO.
33% bajo tto antiarrítmico.
Complications/events In-hospital (%) Postdischarge (%)
All complications 7.7 2.6
Major complications 1.7 0.8
Mortality 0.07 0.31
CV mortality 0.07 0.16
Atrial Fibrillation Ablation Pilot Registry
Follow-up status
Adverse events during 12-month follow-up Cerebrovascular event, % 0.54 Phrenic nerve injury, % 0.16 Esophageal perforation/fistula, % 0 PV stenosis (≥75%) requiring intervention, % 0.08 Vascular injury
AV fistula, % Pseudoaneurysm, %
0.47 0.24
Pacemaker implantation, % 1.02 Death, %
Cardiovascular, % Non-cardiovascular, %
Unknown, %
0.31 0.08 (1 hemorrhagic stroke, 1 ischemic VF)
0.08 (1 other) 0.16
OVERALL, % 2.6
PRAGUE-12
Patients Maze procedure
with surgery (%)
No maze procedure
with surgery (%)
p
All patients
(n=224)
60.2 35.5 0.002
Paroxysmal AF 61.9 58.3 1.00
Persistent AF 72 50 0.194
Longstanding,
persistent AF
53.2 13.9 <0.001
Dr Petr Widimsky
Gracias por su
atención ...