1. Outcome of tailored therapy in rheumatic heart disease with persistent atrial fibrillation (RHD‐AF).
- Author
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Saggu, Daljeet Kaur, Subramaniam, Muthiah, Korabathina, Radhika, Raju, B. Soma, Atreya, Auras R., Reddy, Prasad, Kumar, D. N., Menon, Rajeev, Yalagudri, Sachin, Kapadiya, Anuj, Chennapragada, Sridevi, and Narasimhan, Calambur
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DISEASE risk factors , *ATRIAL fibrillation treatment , *RISK assessment , *ELECTRIC countershock , *ANTICOAGULANTS , *TRANSESOPHAGEAL echocardiography , *T-test (Statistics) , *LEFT heart atrium , *VENTRICULAR ejection fraction , *HOSPITAL care , *FISHER exact test , *PULMONARY artery , *TREATMENT effectiveness , *PEPTIDE hormones , *HEART failure , *HEART valve diseases , *VITAMIN K , *MANN Whitney U Test , *CHI-squared test , *ORAL drug administration , *CALCIUM antagonists , *DESCRIPTIVE statistics , *HEART conduction system , *LONGITUDINAL method , *THROMBOEMBOLISM , *CATHETER ablation , *DISEASE relapse , *CARDIAC pacing , *COMPARATIVE studies , *DATA analysis software , *SYSTOLIC blood pressure , *RHEUMATIC heart disease , *MYOCARDIAL depressants , *LEFT ventricular dysfunction , *DISEASE complications , *CHEMICAL inhibitors - Abstract
Introduction: Rheumatic heart disease with persistent atrial fibrillation (RHD‐AF) is associated with increased morbidity. However, there is no standardized approach for the maintenance of sinus rhythm (SR) in them. We aimed to determine the utility of a stepwise approach to achieve SR in RHD‐AF. Methods: Consecutive patients with RHD‐AF from July 2021 to August 2023 formed the study cohort. The stepwise approach included pharmacological rhythm control and/or electrical cardioversion (Central illustration). In patients with recurrence, additional options included AF ablation or pace and ablate strategy with conduction system pacing or biventricular pacing. Clinical improvement, NT‐proBNP, 6‐Minute Walk Test (6MWT), heart failure (HF) hospitalizations, and thromboembolic complications were documented during follow‐up. Results: Eighty‐three patients with RHD‐AF (mean age 56.13 ± 9.51 years, women 72.28%) were included. Utilizing this approach, 43 (51.81%) achieved and maintained SR during the study period of 11.04 ± 7.14 months. These patients had improved functional class, lower NT‐proBNP, better distance covered for 6MWT, and reduced HF hospitalizations. The duration of AF was shorter in patients who achieved SR, compared to those who remained in AF (3.15 ± 1.29 vs 6.93 ± 5.23, p = 0.041). Thirty‐five percent (29) maintained SR after a single cardioversion over the study period. Only one underwent AF ablation. Of the 24 who underwent pace and ablate strategy, atrial lead was implanted in 22 (hybrid approach), and 50% of these achieved and maintained SR. Among these 24, none had HF hospitalizations, but patients who maintained SR had further improvement in clinical and functional parameters. Conclusions: RHD‐AF patients who could achieve SR with a stepwise approach, had better clinical outcomes and lower HF hospitalizations. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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