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HIGH RATES OF CONCOMITANT ANTIPLATELET USE IN PATIENTS WITH ATRIAL FIBRILLATION TREATED WITH ORAL ANTICOAGULATION: INSIGHTS FROM THE STROKE PREVENTION AND RHYTHM INTERVENTIONS IN ATRIAL FIBRILLATION (SPRINT-AF) REGISTRY
Abstracts
249 LOW-VOLTAGE AREA BUT NOT THE FRACTIONATION SURFACE AREA PREDICTS RECURRENCES AFTER STEPWISE ABLATION OF PERSISTENT ATRIAL FIBRILLATION A Enriquez, F Sadiq Ali, K Michael, C Simpson, H Abdollah, M Jansen, A Baranchuk, D Redfearn Kingston, Ontario BACKGROUND:
Catheter ablation is a highly effective therapy for the long-term management of paroxysmal atrial fibrillation (AF), but the results in persistent AF are more limited. Predictors of success after ablation in this group of patients, especially if long-standing, are not well defined. AIM: The purpose of this study was to determine the association between complex atrial fractionated electrograms (CFAE) surface area or low-voltage area with long-term outcomes after catheter ablation for long-standing persistent AF. METHODS: We included 68 patients with persistent AF 12 months undergoing de novo catheter ablation using a stepwise approach. Bipolar electrogram fractionation and voltage were registered during AF. Regions with a mean cycle length (mCL) between 50-120 ms were considered CFAE and a peak-to-peak bipolar voltage less than 0.1 mV was defined as abnormal. RESULTS: The mean age of the patients was 64 9 years, with 76% being male, duration of AF 86 94 months, LA volume 132 36 ml. Conversion to sinus rhythm or organization into atrial tachycardia with ablation was achieved in 69% of patients during ablation. CFAE involved 48 17% of the LA area and low-voltage was recorded from 11 11%. After a follow-up of 23 14 months 51% of patients were free of arrhythmia recurrences. In patients that recurred the area of low-voltage was greater than in those who remained free of arrhythmias (8 vs 15%, p 0.03). No differences were observed regarding the CFAE surface area. CONCLUSION: In conclusion, among patients with longstanding persistent AF a larger low-voltage area is associated with increased recurrence of arrhythmia during follow-up.
250 HIGH RATES OF CONCOMITANT ANTIPLATELET USE IN PATIENTS WITH ATRIAL FIBRILLATION TREATED WITH ORAL ANTICOAGULATION: INSIGHTS FROM THE STROKE PREVENTION AND RHYTHM INTERVENTIONS IN ATRIAL FIBRILLATION (SPRINT-AF) REGISTRY M Gupta, N Singh, S Verma, JL Cox, P Dorian, C Fournier, DJ Gladstone, E Lockwood, G Mancini, C Saldanha, A Shuaib, M Kajil, M Tsigoulis, AC Ha Toronto, Ontario
Among patients with atrial fibrillation (AF) treated with oral anticoagulation (OAC) for stroke prevention, concomitant use of antiplatelet (AP) agents increases bleeding risk. Also, when compared to OAC alone, additional AP use confers uncertain benefits in terms of reduction of ischemic
BACKGROUND:
S183
vascular events. Since little is known regarding the factors which influence the use of OAC+AP vs. OAC alone in current clinical practice, we sought to identify them in a contemporary, national, observational registry. METHODS: From December 2012 to July 2013, a crosssectional analysis of 850 consecutive AF patients was performed. They were enrolled from 101 practices in 7 Canadian provinces. Demographics of patients treated with OAC+AP (primarily aspirin) vs. OAC alone were identified. Multivariable logistic regression was performed to identify factors associated with OAC+AP vs. OAC use. RESULTS: Seven hundred and five (87%) patients were treated with OAC, amongst whom 135 (19%) were treated with OAC+AP and 570 (81%) were treated with OAC alone. Amongst patients treated with OAC+AP, 58 (43%) did not have a known history of coronary artery disease (CAD) (defined as presence of stable CAD, acute coronary syndrome, percutaneous coronary intervention (PCI), or coronary artery bypass surgery) or peripheral arterial disease (PAD). In the OAC+AP group, 38 (28%) patients had PCI and 51 (38%) patients had diabetes. Patients treated with OAC+AP vs. OAC alone did not significantly differ in age: 77.5 (71.4, 82.3) vs. 76.9 (69.0, 83.0) years (median, IQR). On univariable analysis, male sex, dyslipidemia, PAD, non-CNS systemic embolism, and CAD were associated with OAC+AP use (vs. OAC alone). On multivariable analysis, CAD (OR 4.20, 95% CI 2.83 to 6.24, p<0.01) and male sex (OR 1.60, 95% CI 1.01 to 2.61, p¼0.047) were associated with OAC+AP use. CONCLUSION: In this contemporary registry of AF patients treated with OAC for stroke prevention, we found that 1 in 5 patients was treated with OAC+AP. Although a history of CAD was associated with OAC+AP use, a substantial proportion of patients in this subgroup did not have compelling indications for being treated with AP agents (e.g. history of PCI). Since OAC+AP use increases bleeding risk without discernible benefits in stroke or myocardial infarction reduction, the relatively high rate of AP co-prescription in OACtreated AF patients represents a potential practice gap. Efforts are needed to address this practice pattern to minimize the over-prescription of AP agents in this patient population. Bayer Inc.
251 PREDICTORS OF DEATH AND STROKE IN PATIENTS WITH PAROXYSMAL ATRIAL FIBRILLATION: RESULTS FROM THE CANADIAN REGISTRY OF ATRIAL FIBRILLATION A Ahmadi, A Parsa, J Swampillai, S Connolly, P Dorian, M Green, K Humphries, G Klein, H Qian, M Talajic, C Kerr Vancouver, British Columbia INTRODUCTION:
Atrial Fibrillation is the most commonly encountered sustained arrhythmia. Following initial diagnosis, AF can be associated with poor outcomes such as death and stroke. A paucity of data exists regarding risk factors associated
249 LOW-VOLTAGE AREA BUT NOT THE FRACTIONATION SURFACE AREA PREDICTS RECURRENCES AFTER STEPWISE ABLATION OF PERSISTENT ATRIAL FIBRILLATION A Enriquez, F Sadiq Ali, K Michael, C Simpson, H Abdollah, M Jansen, A Baranchuk, D Redfearn Kingston, Ontario BACKGROUND:
Catheter ablation is a highly effective therapy for the long-term management of paroxysmal atrial fibrillation (AF), but the results in persistent AF are more limited. Predictors of success after ablation in this group of patients, especially if long-standing, are not well defined. AIM: The purpose of this study was to determine the association between complex atrial fractionated electrograms (CFAE) surface area or low-voltage area with long-term outcomes after catheter ablation for long-standing persistent AF. METHODS: We included 68 patients with persistent AF 12 months undergoing de novo catheter ablation using a stepwise approach. Bipolar electrogram fractionation and voltage were registered during AF. Regions with a mean cycle length (mCL) between 50-120 ms were considered CFAE and a peak-to-peak bipolar voltage less than 0.1 mV was defined as abnormal. RESULTS: The mean age of the patients was 64 9 years, with 76% being male, duration of AF 86 94 months, LA volume 132 36 ml. Conversion to sinus rhythm or organization into atrial tachycardia with ablation was achieved in 69% of patients during ablation. CFAE involved 48 17% of the LA area and low-voltage was recorded from 11 11%. After a follow-up of 23 14 months 51% of patients were free of arrhythmia recurrences. In patients that recurred the area of low-voltage was greater than in those who remained free of arrhythmias (8 vs 15%, p 0.03). No differences were observed regarding the CFAE surface area. CONCLUSION: In conclusion, among patients with longstanding persistent AF a larger low-voltage area is associated with increased recurrence of arrhythmia during follow-up.
250 HIGH RATES OF CONCOMITANT ANTIPLATELET USE IN PATIENTS WITH ATRIAL FIBRILLATION TREATED WITH ORAL ANTICOAGULATION: INSIGHTS FROM THE STROKE PREVENTION AND RHYTHM INTERVENTIONS IN ATRIAL FIBRILLATION (SPRINT-AF) REGISTRY M Gupta, N Singh, S Verma, JL Cox, P Dorian, C Fournier, DJ Gladstone, E Lockwood, G Mancini, C Saldanha, A Shuaib, M Kajil, M Tsigoulis, AC Ha Toronto, Ontario
Among patients with atrial fibrillation (AF) treated with oral anticoagulation (OAC) for stroke prevention, concomitant use of antiplatelet (AP) agents increases bleeding risk. Also, when compared to OAC alone, additional AP use confers uncertain benefits in terms of reduction of ischemic
BACKGROUND:
S183
vascular events. Since little is known regarding the factors which influence the use of OAC+AP vs. OAC alone in current clinical practice, we sought to identify them in a contemporary, national, observational registry. METHODS: From December 2012 to July 2013, a crosssectional analysis of 850 consecutive AF patients was performed. They were enrolled from 101 practices in 7 Canadian provinces. Demographics of patients treated with OAC+AP (primarily aspirin) vs. OAC alone were identified. Multivariable logistic regression was performed to identify factors associated with OAC+AP vs. OAC use. RESULTS: Seven hundred and five (87%) patients were treated with OAC, amongst whom 135 (19%) were treated with OAC+AP and 570 (81%) were treated with OAC alone. Amongst patients treated with OAC+AP, 58 (43%) did not have a known history of coronary artery disease (CAD) (defined as presence of stable CAD, acute coronary syndrome, percutaneous coronary intervention (PCI), or coronary artery bypass surgery) or peripheral arterial disease (PAD). In the OAC+AP group, 38 (28%) patients had PCI and 51 (38%) patients had diabetes. Patients treated with OAC+AP vs. OAC alone did not significantly differ in age: 77.5 (71.4, 82.3) vs. 76.9 (69.0, 83.0) years (median, IQR). On univariable analysis, male sex, dyslipidemia, PAD, non-CNS systemic embolism, and CAD were associated with OAC+AP use (vs. OAC alone). On multivariable analysis, CAD (OR 4.20, 95% CI 2.83 to 6.24, p<0.01) and male sex (OR 1.60, 95% CI 1.01 to 2.61, p¼0.047) were associated with OAC+AP use. CONCLUSION: In this contemporary registry of AF patients treated with OAC for stroke prevention, we found that 1 in 5 patients was treated with OAC+AP. Although a history of CAD was associated with OAC+AP use, a substantial proportion of patients in this subgroup did not have compelling indications for being treated with AP agents (e.g. history of PCI). Since OAC+AP use increases bleeding risk without discernible benefits in stroke or myocardial infarction reduction, the relatively high rate of AP co-prescription in OACtreated AF patients represents a potential practice gap. Efforts are needed to address this practice pattern to minimize the over-prescription of AP agents in this patient population. Bayer Inc.
251 PREDICTORS OF DEATH AND STROKE IN PATIENTS WITH PAROXYSMAL ATRIAL FIBRILLATION: RESULTS FROM THE CANADIAN REGISTRY OF ATRIAL FIBRILLATION A Ahmadi, A Parsa, J Swampillai, S Connolly, P Dorian, M Green, K Humphries, G Klein, H Qian, M Talajic, C Kerr Vancouver, British Columbia INTRODUCTION:
Atrial Fibrillation is the most commonly encountered sustained arrhythmia. Following initial diagnosis, AF can be associated with poor outcomes such as death and stroke. A paucity of data exists regarding risk factors associated