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Funding Acknowledgements Type of funding sources: None. Introduction The incidence of ventricular tachycardia (VT) and ventricular fibrillation (VF) in the acute phase of infarction (first 24-48 hours) has declined over recent decades, probably due to the uptake of reperfusion strategies and the early use of beta-blockers. However, according to some series, 6–8% of patients still develop hemodynamically significant VT or VF during this phase. Purpose The objective of our study was to evaluate the baseline characteristics of patients who suffered VT or VF in the acute phase of the infarction and to create a predictive model of ventricular arrhythmias in this setting which allow us to anticipate arrhythmic events. Methods We performed an observational, retrospective, and single-centre study carried out through the review of clinical records of patients who suffered an acute myocardial infarction with ST-segment elevation (STEMI) and were admitted in our Coronary Care Unit between July 2011 and August 2022. Results In our cohort we observed 179 episodes of VT/VF (10,7%) in a population of 1668 patients underwent STEMI. The mean age in this subgroup was 61,69±12,61 years old, 78% were males and 56% smokers. Approximately a quarter of the patients were diabetic or obese. There was a very low percentage of previous myocardial infarction (12%) and heart failure (3%) (Table 1). We estimated the best prediction model (Mallows’ Cp=5.12) for VT/VF. The variables included in our model (LL=-435,43) were: male sex, absence of diabetes, smoking habit, use of fibrinolysis, worst Killip at admission and hypotension at admission (Table 2). Conclusion The presence of VT or VF in the acute phase of infarction is still considered a controversial factor in the prognosis of these patients. In our cohort we identified that males, smokers, non-diabetics, and the use of fibrinolysis and the worst haemodynamical situation at admission were independent predictors of developing VT/VF in this context.
Introduction Tachycardiomyopathy is a common cause of left ventricular systolic dysfunction (LVSD), whose complete resolution after arrhythmia control is highly variable among patients. Purpose To assess the associated factors with complete left ventricular reverse remodeling (CLVRR) in patients with confirmed tachycardiomyopathy. Methods Retrospective single-centre, observational study of consecutive patients with diagnosed tachycardiomyopathy between January 2015–2022. CLVRR was defined by a recovered left ventricular ejection fraction (RLVEF) >55% and a left ventricular end-dyastolic diameter (LVEDD) <55 mm assessed by transthoracic echocardiography. Results 134 patients were gathered in this period. Patients with previous known LVSD or LV dilatation were excluded from the analysis (n=6). Baseline characteristics are displayed in Image 1. Most frequent arrhythmia was atrial fibrillation (73.8%), followed by atrial flutter (25.4%), atrial tachycardia (2.2%) and ventricular extrasystole (5.2%). 99.2% of patients were treated with beta-blockers, 71.6% with ACEI/ARBs, 23.9% with neprilysin inhibitors and 64.2 with aldosterone receptor antagonist. Rhythm control was achieved in 82.1% of patients, of whom 80% underwent an ablation procedure after a mean of 8.2 months. After 10.8 months since LVSD, mean RLVEF was 55.4% (+6.3) and mean LVEDD 52.1 mm (+5.8). CLVRR was observed in 50% of patients. A multivariate analysis was performed in a stepwise fashion to assess associated factors, including baseline information (medical history, echocardiographic information and received treatment, both pharmacological and ablation). CLVRR was associated with female-sex (coefficient 1.18; p=0.009) and severe baseline left ventricular disfunction (coefficient −0.80; p=0.041), corrected by previous alcohol abuse history (coefficient 0.94; p=0.055) and a rhythm-control strategy (coefficient 0.98; p=0.052) which didn't reach complete statistical significance. Conclusion Women, patients without severe LV dysfunction at baseline, with history of previous alcohol abuse and receiving a rhythm-control strategy were associated with a complete left ventricular reverse remodeling in patients with tachycardiomyopathy. Funding Acknowledgement Type of funding sources: None.
Funding Acknowledgements Type of funding sources: None. Introduction Atrial fibrillation (AF) and ischemic cardiomyopathy share common risk factors. The aim of the study was to analyse clinical profile and mortality of patients presenting new-diagnosed AF in the context of acute coronary syndrome (ACS). Methods Retrospective, observational study of patients presenting with ACS in Acute Coronary Care Unit (ACCU) between 2011-2022. Baseline, demographic characteristics and clinical outcomes were studied. Results 3161 patients with ACS were admitted to the ACCU during this period, of whom 5.1% presented de-novo AF. The remaining percentage were patients without AF (86.8%) or with previously known AF (8.1%). 73.7% were male and 52.8% of the ACS presented with ST elevation. Baseline characteristics in both groups are shown in Table 1. Most frequent culprit vessel was the anterior descending artery in both groups, followed by right coronary artery. Severe bleeding was significantly more frequent in patients with de-novo AF (25.4% vs 9%, p<0.01). On univariate analysis, in-hospital all-cause mortality was significantly higher in the de-novo AF group (17.3% vs 5.8%, p<0.01), as well as in patients with previously known AF (10.9% p<0.01), compared to those without AF. In the multivariate analysis of all-cause mortality (Table 2) after adjusting for baseline characteristics, de-novo AF did not reach statistical significance. Conclusion De-novo AF is a relatively uncommon complication in ACS, identifying a high-risk profile patient with higher in-hospital mortality.
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