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Quality of Life in Patients with Typical Atrial Flutter Following Cavotricuspid Isthmus Ablation . The Santiago Cohort. José Ramón González Juanatey Cardiology and Intensive Cardiac Care Department University Hospital. Santiago de Compostela. Spain. Atrial Tachycardias. Focal.

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Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Quality of Life in PatientswithTypical Atrial FlutterFollowingCavotricuspidIsthmusAblation.

The Santiago Cohort

José Ramón González Juanatey

Cardiology and IntensiveCardiacCareDepartment

University Hospital. Santiago de Compostela. Spain


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Atrial Tachycardias

Focal

Macroreentry

● Flúter auricular derecho

Flúter auricular dependiente del istmo cavotricuspídeo

- Típico o antihorario

- Típico reverso u horario

- Reentrada de doble onda

- Reentrada inferior (lower loop reentry)

- Reentrada intraístmica

Flúter auricular no dependiente del istmo cavotricuspídeo

- Reentrada de la pared libre derecha

- Incisional

- Reentrada superior (upper loop reentry)

● Flúter auricular izquierdo

- Perimitral

- En relación con venas pulmonares

- Septal

●Automatismo

●Actividad desencadenada

●Microreentrada

Atrial Flutter. Clasification

Saoudi et al. Eur Heart J 2001;22:1162-82


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Reverse Typical Atrial Flutter. ECG

Flutter Wave: ♦ Componente negativo que precede al positivo en derivaciones inferiores. A veces este componente lo hace indistinguible del Fl típico.

♦ Melladura en derivaciones inferiores y V1

♦V1 negativa y mellada

♦DI positiva

♦aVL negativa


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Improve Survival

Increase functional

capacity

Improve Atrial dysfunction

Atrial Flutter

Ablation

Clinical Objectives

Reduce Morbidity

Symptoms

improvement

Electrical stability

Increase Quality of Life

BP=blood pressure; COPD=chronic obstructive pulmonary disease


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Quality of Life and Atrial Flutterablation

  • Differentstudieshaveprovedanimprovement in QoLafter CTI AFlablation1-5 butmost of them:

    • Notstandardizednornormalized (americanpopulation).

    • Standardized and normalized to americanbutnot to ownpopulation.

    • Notadjustedbyage and sex (theoldesthavepoorQoL and malehavebetterQoLthanfemale).

    • Subgroups has notbeenanalized (especially atrial fibrillation).

    • Results has neverbeenexpressed as importantclinicalminimaldifferences (MID). This concept allows to knowif a treatment produces a relevantclinicalbenefit to thepatient and notonlystatisticallysignificantchanges.

    • Notevaluation in a short and long-term.

    • NotEvaluation of structural and functionalcardiacchanges.

1. Calkins et al. Am J Cardiol 2004; 94:437-42; 2. O´Callaghan et al Heart 2001;86:167-71; 3. Feld et al. Am CollCardiol2004;43:1466-72; 4. Lee et al. Am J Cardiol1999;84:278-83.5. Meissner et al. Clin Res Cardiol 2007;96:1-9.


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

GarciaSeara et al. RevEspCardiol 2011;64:401-408


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Atrial Flutter Santiago Cohort. ClinicalCharacteristics


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Atrial Flutter Santiago Cohort. ClinicalCharacteristics


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Short Form (SF-36) Quality of LifeQuestionnaire


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

FlutterAblation. ProcedureComplications and Follow-up


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

80

60

40

20

0

-20

CSM

CSF

FF

RF

DC

SG

VT

AS

RE

SM

BaselineQuality of Life. Standarized and NormalizedfortheSpanishPopulation. Age and gender-adjusted

CSF: componentsummaryPhysical

CSM: componentsummaryMental

SD: Estándardeviation

FF: función física

RF: rol físico

DC: dolor corporal

SG: salud general

VT: vitalidad

AS: actividad social

RE: rol emocional

SM: salud mental

Population Mean and SD: 50 ± 10

Light Deviations: > 4 puntos

Moderate Deviations: > 6 puntos

Severe Deviations: > 8 puntos

GarciaSeara et al. Cuad. Estimulación cardíaca 2010:31-41


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

1-year Quality of Life. Standarized and NormalizedfortheSpanishPopulation. Age and gender-adjusted

SG:salud general

VT: vitalidad

AS: actividad social

RE: rol emocional

SM: salud mental

CSF: componentsummaryPhysical

CSM: componentsummaryMental

FF: función física

RF: rol físico

DC: dolor corporal

GarciaSeara et al. Cuad. Estimulación cardíaca 2010:31-41


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Quality of Life at Baseline and 1-Year Follow-up, Standarized and NormalizedfortheSpanishPopulation.

AdjustedforAge and Gender

GarciaSearaJ, …, González-Juanatey JR et al. RevEspCardiol 2011;64:401-408


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

AbsoluteDifferences in Quality of Life at Baseline and 1-Year Follow-up,

Standarized and NormalizedfortheSpanishPopulation. AdjustedforAge and Gender

FF: función física

RF: rol físico

DC: dolor corporal

SG: salud general

VT: vitalidad

AS: actividad social

RE: rol emocional

SM: salud mental

*p<0,05;CSF: componentsummaryPhysical ;CSM: componentsummaryMental; SD: standarddeviation

Population Mean and SD: 50 ± 10

Light Deviations: > 4 puntos

Moderate Deviations: > 6 puntos

Severe Deviations: > 8 puntos

GarciaSeara et al. RevEspCardiol.2011


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Differences in Quality of Life at Baseline and 1-Year Follow-up

Standarized and NormalizedfortheSpanishPopulation. AdjustedforAge and Gender

ES: Effectsize

SRM: Standarized Response Mean

MCID: Minimumclinicallyimportantdifference

CSF: ComponentsummaryPhysical; CSM: ComponentsummaryMental

● ≥0,80: ImportantVariations

●0,50-0,79: ModerateVariations

●0,20-0,49: Light Variations

●0,01-0,19: VerymodestVariations

GarciaSeara et al. RevEspCardiol.2011;64;401-08


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Differences in Quality of Life at Baseline and 1-Year Follow-up

Atrial FibrillationduringtheFollow-up

FF: función física

RF: rol físico

DC: dolor corporal

SG: salud general

VT: vitalidad

AS: actividad social

RE: rol emocional

SM: salud mental

*p<0,05; Los datos se expresan en mean ± SD

SD: standarddeviation

GarciaSeara et al. HealthQualLifeOutcomes 2012


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Quality of LifeDimensions at 1-Year

Atrial FibrillationduringFollow-up

VT: vitalidad

AS: actividad social

RE: rol emocional

SM: salud mental

FF: función física

RF: rol físico

DC: dolor corporal

SG: salud general

*p<0,05; Data are expressed as mean ± SD

CSF: componentsummaryPhysical

CSM: componentsummaryMental

SD: standarddeviation

GarciaSeara et al. HealthQualLifeOutcomes 2012


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Differences in Quality of Life at Baseline and 1-Year Follow-up

Type of Atrial Flutter

FF: función física

RF: rol físico

DC: dolor corporal

SG: salud general

VT: vitalidad

AS: actividad social

RE: rol emocional

SM: salud mental

*p<0,05; Data are expressed as mean ± D

DE: Standard deviation


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Quality of LifeDimensions at 1-Year

Type of of Atrial Flutter

FF: función física

RF: rol físico

DC: dolor corporal

SG: salud general

VT: vitalidad

AS: actividad social

RE: rol emocional

SM: salud mental.

*p<0,05; Data are expressed as mean ± SD and [median].


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Differences in Quality of Life at Baseline and 1-Year Follow-up

Gender

FF: función física

RF: rol físico

DC: dolor corporal

SG: salud general

VT: vitalidad

AS: actividad social

RE: rol emocional

SM: salud mental

*p<0,05; Los datos se expresan en media ± DE

SD: standarddeviation


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Differences in Quality of Life at Baseline and 1-Year Follow-up

StructuralCardiacDisease

FF: función física

RF: rol físico

DC: dolor corporal

SG: salud general

VT: vitalidad

AS: actividad social

RE: rol emocional

SM: salud mental

*p<0,05; Los datos se expresan en media ± DE

SD: standarddeviation


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Differences in Quality of Life at Baseline and 1-Year Follow-up

Number of Episodes

FF: función física

RF: rol físico

DC: dolor corporal

SG: salud general

VT: vitalidad

AS: actividad social

RE: rol emocional

SM: salud mental

*p<0,05; Los datos se expresan en media ± DE

SD: standarddeviation


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Differences in Quality of Life at Baseline and 1-Year Follow-up

PersistentFlutter and Ventricular Cycle

FF: función física

RF: rol físico

DC: dolor corporal

SG: salud general

VT: vitalidad

AS: actividad social

RE: rol emocional

SM: salud mental

*p<0,05; Los datos se expresan en media ± DE

SD: standarddeviation

GarciaSeara et al. HealthQualLifeOutcomes 2012


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Differences in Quality of Life at Baseline and 1-Year Follow-up

FlutterType / Ventricular Cycle / StructuralHeartDisease

*p<0,05. Los datos se expresan en media ± DE. FF: función física; RF: rol físico; DC: dolor corporal; SG: salud general; VT: vitalidad; AS: actividad social; RE: rol emocional; SM: salud mental, CSF: componente sumario físico, CSM: componente sumario mental; TES: transición del estado de salud; FlApers.: flúter persistente, FlAparox.: flúter paroxístico; Cp: cardiopatía

GarciaSeara et al. HealthQualLifeOutcomes 2012


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Structural and FunctionalCardiacRemodeling.

Differencesamongcardiacstructural and funcional parameters

*p<0,05

Cuantitative data are expressed as mean ± SD

● AD: Aurícula derecha

● cf: fracción de acortamiento

● AI: aurícula izquierda

● dAI: dimensión de aurícula izquierda

● FEVI: fracción de eyección de ventrículo izquierdo

● VD: ventrículo derecho

● FC: frecuencia cardíaca

● E: velocidad máxima de onda E

● A: velocidad máxima de onda A

● E/A:cociente entre E y A

● TdecE: tiempo de deceleración de la onda E

● TRIV:tiempo de relajaciónisovolumétrica

● TIV: tabique interventricular

● DTD:diámetrotelediastólico de VI

● DTS:diámetrotelesistólico de VI

● PP: pared posterior de VI

GarciaSeara et al. RevEspCardiol 2012


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Structural and FunctionalCardiacRemodeling.

Differencesamongcardiacstructural and funcional parameters

DiastolicLeft Ventricular Function

P=0,22

P=0,000

GarciaSeara et al. RevEspCardiol 2012


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Quality of Life at Long-termafter CTI Ablation

p*: baseline- 1 y

p**: baseline- 6 y


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Quality of Life at Long-termafter CTI Ablation

Cabanas-Grandío et al. HealthQualLifeOutcomes 2014


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Quality of Life at Long-termafter CTI Ablation

Cabanas-Grandío et al. HealthQualLifeOutcomes 2014


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Quality of Life at Long-termafter CTI Ablation. Atrial Fib


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Quality of Life at Long-termafter CTI Ablation

Chronic Oral Anticoagulation


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Quality of Life at Long-termafter CTI Ablation. Diabetes


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

FactorsRelatedto Long-termQuality of Lifeafter CTI Ablation

PhysicalComponentSummary

Mental ComponentSummary

Cabanas-Grandio P et al. Health and QofLOutcomes. 2014; 12: 47


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Atrial Fibrillation-free Survival.

Atrial FlAblation Santiago Cohort

Seara JG et al. Clin Res in Cardiol. 2014


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Atrial FibIncidenceafter CTI Ablation.

The Santiago Cohort


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Atrial Fib, Stroke and DeathRiskafter Atrial FlutterAblation


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Atrial Fibrillation, Stroke and DeathDeterminants in Patientswith CTI Ablation. MultivariateAnalysis


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Stroke and DeathDeterminants in Patientswith Atrial FibrillationduringFollow-up. MultivariateAnalysis


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Atrial FibRecurrenceafter CTI Ablation.

The Santiago Cohort

Group 3: isolated AFL

Group 2: Afib + AFL

Group 1: IC AFL

García Seara et al. Int J Cardiol. June 2014


Jos ram n gonz lez juanatey cardiology and intensive cardiac care department

Conclusions

  • A clinicallysignificativeimprovement in HRQoLmeasuresafter 1-year wasfound in patientswithtypical trial flutterwhounderwentcavotricuspidisthmuscatheterablation and can be offered as a validtherapeutic alternativa tomost of thepatients

  • In ourpopulationwefoundinversestructural and functionalcardiacremodelling at 1-year follow-up withmuchimprovedleft ventricular ejectionfraction, rightatriumcontractionfraction, and diastolicdysfunctionpattern.

  • CTI ablationprovides a sugnificantimprovement in long-termQoLforthedimensions of Physical Role, Vitality and Mental Health. Previous diabetes mellitus, Atrial Fib, oral anticoagulation, basal QoL and Atrial Flutterrecurrenceweredeterminants of a worselong-termQoL.

  • Patientswith Atrial Fibduringfollow-up show a significantloweHRQoL at 1-year post-ablation.


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