Arritmias/Insuficiencia cardiaca

18 Marzo a las 14:00h
Casa del Corazón, Madrid
La Sociedad Española de Cardiología
en colaboración con MSD,
presentan en directo

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AATAC Multicenter Randomized Trial:
Ablation vs Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients
With Congestive Heart Failure and an Implanted device (ICD/CRTD)
Catheter ablation compared with Amiodarone among patients with persistent
atrial fibrillation and heart failure.
Group 1 and 2 did not
differ in their baseline
characteristics:
Left atrium size (48 mm)
Median AF duration 8.5 m
LVEF 30%

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Follow-up 26±8 month
Primary Endpoint: Long-term procedural-success. freedom from
AF, AFL, or AT of > 30 second duration off-AAD

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80
22
In the 102 patients
undergoing
catheter ablation
PVI plus posterior wall
and non PV trigger
ablation
PVI alone
78,8
36,4
0
10
20
30
40
50
60
70
80
90
PVI plus posterior
wall and non PV
trigger ablation
PVI alone
Higher success rate in patients
undergoing PVI plus ablation
compared to PVI alone (%)

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31
57
0
10
20
30
40
50
60
Catheter ablation
(n=102)
Amiodarone
(n=101)
Hospitalization (%)
p<0,001
All cause Mortality (%)
p<0,037
8
18
0
5
10
15
20
Catheter ablation
(n=102)
Amiodarone
(n=101)
Cardiac related re-hospitalizations during post-
ablation follow- up (AF/CHF related).

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Surgical Ablation of Atrial Fibrillation during Mitral Valve Surgery:
A Randomized Clinical Trial from the Cardiothoracic Surgical Trials Network
No Ablation Pulmonary vein isolation Biatrial Maze
LAA closure performed in all patients
Patients with mitral valve disease undergoing open heart surgery.
Persistent (>7 days) or long-standing persistent (>1 year) atrial fibrillation.
Compare mitral valve surgery plus ablation vs mitral valve surgery alone.
Mean patient age: 70 years
Percentage female: 43%
NYHA III-IV: 45% EF: 55%
Type of atrial fibrillation: persistent 47%, long-standing persistent 53%
Mitral valve surgery: replacement 41%, repair 59%

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29,4
63,2
0
20
40
60
80
MVS Alone MVS +
Ablation
FreedomFromAF(%)
Risk Difference of Success
0.34 (95% CI, 0.21 - 0.47), P<0.001
Randomization Group
Primary Endpoint
66
61
0
20
40
60
80
100
Biatrial
Lesions
PVI
Ablation Group
Biatrial Maze vs. PVI
FreedomFromAF(%)
Risk Difference of Success
0.05 (95% CI, -0.13 - 0.23), P=0.60
Freedom from AF at both 6 and 12
months by 3-day Holter monitor
Total number of enrollees: 260 Follow-up: 12 months

Mortality(%)
Mortality
Months
MACCE
CompositeCardiacEndPoint(%)
Months
8.7%
6.8%
23.3%
20.5%
Major adverse cardiac or cerebrovascular events
Quality of Life
MVS Alone
(N=127)
MVS & Ablation
(N=133)
P-Value
SF-12
Physical Function 45.3 ±7.9 44.3 ±9.0 0.38
Mental Function 48.5 ±6.5 48.0 ±6.3 0.56
AF Severity Scale
Daily AF –no. (%) 42 (45.2) 20 (19.8) <0.001
Life Rating (1-10, median) 8.0 (7,9) 8.0 (7,9) 0.45
NYHA Class III + IV –no. (%) 3 (2.9) 8 (7.0) 0.17

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120
143
0
50
100
150
200
MVS Alone MVS + Ablation
SAE(Rate/100Pt-Yrs)
Incidence Rate Ratio
1.20 (95% CI, 0.95 - 1.51), P=0.12
Randomization Group
Serious Adverse Events
8,1
21,5
0
10
20
30
MVS Alone MVS +
Ablation
Incidence Rate Ratio
2.64 (95% CI, 1.20 - 6.41), P<0.001
Pacemaker Implantation
Randomization Group
Pacemakerimplantation(%)
SAE: HF, Stroke, Conduction abnormality (Pacemaker),
nonperioperative myocardial infarction, renal failure,
Bleeding, Ventricular Arrhythmia, Pneumonia, Sepsis,
Respiratory failure.

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Patients with BMI ≥ 27
N=825
3-9%WL
N=103
Final Cohort
N=355
≥10%WL
N=135
<3%WL or WG
N=117
Patients >65 y + BMI>27 referred
for management of symptomatic
paroxysmal or persistent AFib,
without a history of myocardial
infarction or cardiac surgery in the
previous 12 m.
Similar Baseline
Characteristics.
BMI 33
Weight Management
LEGACY Study:
Long-Term Effect of Goal Directed Weight Management on an Atrial Fibrillation
Cohort: A 5-Year Follow-Up Study

Impact on AF Symptoms
*Group-Time
P<0.001
*Group-Time
P<0.001
AF Symptom Burden
AFib Severity Scale questionnaire
Global Well Being Score

Total Arrhythmia-Free Survival
P<0.001
86%
66%
40%
With AAD +/- ablation
P<0.001
Without AAD or ablation
13%
22%
46%
AF freedom: 7 day Holter monitoring

Structural Remodeling
(ml/m2)
*Group-Time
P<0.001
*Group-Time
P<0.001
(mm)
LA Volume (indexed) Septal Dimension

Weight Fluctuation
P<0.001
85%
59%
44%
With AAD +/- ablationWith AAD +/- ablation
P<0.001
76%
59%
38%
Weight Loss Trend

Multivariate Predictors of AF Recurrence
Weight Loss Weight Fluctuation
≥10% weigh loss was associated
with AF free survival
HR 5.7 [95% CI: 3.3-10.1]
(P<0.001)
>5% weight fluctuation was
associated with AF recurrence
HR 2.2 [95% CI: 1.1-4.2](P<0.001)

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Age >18 y, stable symptomatic systolic HF (NYHA II – IV), LV ejection
fraction <45%. Current episode of major depression diagnosed by
Structured Clinical Interview (SCID)
MOOD-HF Trial
Effects of selective serotonin re-uptake inhibition on MOrtality, mOrbidity and
mood in Depressed Heart Failure patients

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Primary Outcome
Time to all-cause death or
hospitalization
Major Secondary Outcome
10- item Montgomery–Åsberg
Depression Rating Scale
MOOD-HF Trial
Total number of enrollees: 235 Follow-up: 24 months

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AUGMENT–HF trial: A Prospective Comparison of Algisyl-LVR with Standard
Medical Therapy to Determine Impact on Functional Capacity and Clinical
Outcomes in Patients with Advanced Heart Failure.
LVRestorationwithAlgisyl
Placement of Alginate Hydrogel via a Limited Thoracotomy
Algisyl (Algisyl-LVRTM) is a medical device
that consists of an alginate hydrogel that is
injected into the midwall of the LV, where it
remains as a permanent implant that is
intended to reduce LV wall stress and prevent
or reverse the progression of HF

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78 Patients with moderate to severe HF (highly symptomatic, LVEF ≤ 35%,
Peak VO2 of 9.0 - 14.5 mL/min/kg, LVEDDi 30 to 40 mm/m2 (LVEDD/BSA))
that had been treated with optimal medical and/or device therapy
• Primary Efficacy Endpoint: peak VO2 at 6 months assessed by blinded core lab
• Safety Assessments: clinical outcomes over 30 days, 6, 12 and 24 months
• Secondary Endpoints: symptoms, 6 min-WT & cardiac function during follow-up
4038
Algisyl implant procedure
+
optimal medical therapy
optimal medical
therapy alone

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AUGMENT-HF–ChangeinMeanPeakVO2
12.2! 12.3! 12.4!
12.1!
12.9!
13.2!
11(
12(
13(
14(
15(
Usual(Care(
AlgisylSLVR(
Baseline! 3!months! 6!months!
*P<0.014(
RER(Mean(( (1.02(±(0.09( ((((((((((((((((((((((((((((1.03(±(0.12(((((((((((((((((((((((((((((((((((1.02(±(0.11((
mL/kg/min!
AUGMENT-HF–ExerciseTime(CPX), changefrombaseline
*P=0.001(
31.0(
49.0(
S26.0(
S10.0(
S40.0(
S20.0(
0.0(
20.0(
40.0(
60.0(
80.0(
seconds!
3!months!(n=48)!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!6!months!(n=45)!
AlgisylSLVR(
Usual(Care(
AUGMENT-HF6min-WT- changefrombaseline
N9.6! N15.4!
60.8!
84.7!
S50(
0(
50(
100(
150(
3m!(n=63)! 6m!(n=63)!
meters(
Usual(Care(
AlgisylSLVR(
*P<0.001+
NYHAFunctional Class–continuousrepresentation
P*<0.001(
2.9(
2.2(
2.0(
2.8( 2.8( 2.8(
1.0(
2.0(
3.0(
4.0(
Baseline!(n=73)! 3!mo!(n=62)! 6!mo!(n=63)!
NYHA(Class(
AlgisylSLVR(
Usual(Care(

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BAT for HFrEF Study Group: Baroreflex Activation therapy for the Treatment of
Heart Failure with a Reduced Ejection Fraction
Integrated Autonomic Nervous
System Response
Inhibits Sympathetic Activity
Enhances Parasympathetic Activity
Carotid Baroreceptor Stimulation
↓ HR
↓ Remodeling
↑ Vasodilation
↓ Elevated BP
↑ Diuresis
↓ Renin secretion
The Baroreflex as a Therapeutic Target

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Variable
BAT
(n=71)
Med Mgmt
(n=69)
Race: Caucasian 82% 90%
Gender: Female 13% 16%
NYHA: Class III 99% 100%
Age (years) 64 ± 11 66 ± 12
SBP (mmHg) 115 ± 18 119 ± 17
DBP (mmHg) 72 ± 11 73 ± 11
HR (bpm) 73 ± 11 75 ± 12
LVEF (%) 24 ± 7 25 ± 7
eGFR (mL/min) 58 ± 21 59 ± 19
NT-pro BNP (pg/mL)* 1422 [455, 4559] 1172 [548, 2558]
6 Minute Hall Walk (m) 297 ± 79 308 ± 85
MN Living with HF QOL† 51 ± 21 43 ± 22
Number of Meds 4.8 ± 1.6 4.4 ± 1.9
Coronary Artery Disease 66% 68%
History of Atrial Fibrillation 45% 44%
Chronic Kidney Disease 34% 25%
HF hospitalizations prior 6 Mo
(days/pt/year)
7.0 ± 21 2.4 ± 9
*Median [IQR]
†p≤0.05 between groups
Baseline Demographics
N=140

Reduces NT-proBNP LevelsImproves 6-MWT Distance
Improves Quality of Life ScoreImproves NYHA Class

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Variable
BAT
(n=57)
Med Mgmt
(n=50)
Difference
Mean ± SE
HF Hospitalization Days per Year
6 Months Pre-Enrollment 6.95 ± 20.7 2.40 ± 8.6 4.55 ± 34
6 Months Post Enrollment 0.67 ± 2.5 2.48 ± 7.4 -1.82* ± 1
Change from Pre to Post -6.28** ± 2.7 0.08 ± 1.7 -6.36** ± 3
Negative Binomial 6M Post 0.38 2.10 82% RR†*
*p≤0.10; **p≤0.05
†RR – Relative Reduction adjusted for 6 months Pre-Enrollment Heart Failure Hospitalizations (Negative Binomial Model)
Number of Hospitalization Days for Heart Failure

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conclusiones
AATAC: En pacientes con IC sistólica y FA persistente, la ablación con
catéter es más eficaz que el tratamiento con Amiodarona para
mantener el ritmo sinusal a largo plazo. Además se asocia con una
reducción de la mortalidad y las hospitalizaciones
Surgical Ablation of Afib: En pacientes con valvulopatía mitral y FA
persistente, la cirugía valvular mitral y la ablación quirúrgica de la FA
permite un mejor control del ritmo cardíaco, aumentando la proporción
de pacientes libres de FA en el seguimiento
LEGACY: En pacientes obesos con FA paroxística o persistente, la
estrategia de perder peso de forma sostenida evitando fluctuaciones
se relaciona con una reducción dosis dependiente de la carga de FA,
el mantenimiento del Ritmo sinusal y se asocia a un beneficioso
remodelado estructural cardíaco

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Mood HF: En pacientes con IC sistólica sintomática y depresión mayor,
el tratamiento con Escitalopram no mejoró los síntomas depresivos y fue
similar al placebo en términos de mortalidad y hospitalización en el
seguimiento
conclusiones
BAT for HFrEF: La Terapia de Activación de los Baroreceptores
carotideos es segura y mejora los síntomas de los pacientes con ICFER.
Se asocia a una mejoría de la CF, calidad de vida, capacidad de
esfuerzo, NT-proBNP y reducción de las hospitalizaciones por IC.
AUGMENT–HF: La administración de Algisyl intramiocárdico en
pacientes con IC avanzada tiene una morbimortalidad aceptable. Se
relaciona con una mejoría sintomática y aumenta la capacidad
funcional del corazón. Podría tener un potencial impacto favorable en
la reducción de hospitalizaciones por IC

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5. Arritmias / Insuficiencia cardiaca
• AATAC Multicenter Randomized Trial: Ablation vs Amiodarone for Treatment
of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an
Implanted device
• Effectiveness of Surgical Ablation of Atrial Fibrillation during Mitral Valve
Surgery: A Randomized Clinical Trial from the Cardiothoracic Surgical Trials
Network
• LEGACY Study: Long-Term Effect of Goal Directed Weight Management on an
Atrial Fibrillation Cohort: A 5-Year Follow-Up Study.
• Mood HF Trial. Effects of Selective Serotonin Re-Uptake Inhibition on Mortality,
Morbidity and Mood in Depressed Heart Failure Patients
• AUGMENT–HF trial: A Prospective Comparison of Algisyl-LVR with Standard
• BAT for HFrEF : Baroreflex Activation therapy for the Treatment of Heart Failure
with a Reduced Ejection Fraction

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MVS
Alone
(N=127)
MVS &
Ablation
(N=133)
Female –no. (%) 63 (49.6) 57 (42.9)
Age (yr) 69.4 ± 10.0 69.7 ± 10.4
NYHA Class III & IV –no. (%) 62 (49.2) 56 (42.1)
Atrial fibrillation duration –med
(IQR)
29 (3, 96) 18.5 (3, 65)
Atrial fibrillation type 28 (18.7) 24 (16.0)
Longstanding Persistent 71 (55.9) 70 (52.6)
Persistent 56 (44.1) 63 (47.4)
Anticoagulants –no. (%) 97 (76.4) 105 (79.0)
Anti-arrhythmic Drugs (Class III) 15 (11.8) 14 (10.5)
Mitral disease etiology
Organic 73 (57.5) 75 (56.4)
Functional non-ischemic 48 (37.8) 43 (32.3)
Ischemic 6 (4.7) 15 (11.3)
Baseline Characteristics
Total number of enrollees: 260
MVS Alone
(N=127)
MVS &
Ablation
(N=133)
Mitral Valve Surgery
Replacement 61 (48.4) 54 (40.6)
Repair 65 (51.6) 79 (59.4)
Concomitant Procedures
Tricuspid Valve Surgery 48 (38.1) 50 (37.6)
Aortic Valve Replacement 20 (15.9) 14 (10.5)
CABG 25 (19.8) 27 (20.3)
Cardiopulmonary Bypass Time (min)* 132.5 +51 147.8 +63.3
Cross-Clamp Time (min) 95.9 +36.3 102.9 +41.5

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28,8 30,2
38,4 34,6
0
20
40
60
Success Recurrence
Baseline Follow-up
347 352374 360
0
100
200
300
400
Success Recurrence
Baseline Follow-up
LVEF (%) 6MWT (meters)
53 4947 46,6
0
20
40
60
Success Recurrence
Baseline Follow-up
MLHFQ score
p<0,038p<0,001 p<0,013
Change in LVEF, 6MWD, and MLHFQ score by recurrence status
At the end of follow-up, recurrence free patients (n=105) experienced
significantly better improvement in all parameters compared to those who
experienced recurrence (n=98).

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LEGACY Study:
Hypothesis
Weight loss, if sustained, will be of incremental benefit in
rhythm control
Weight fluctuation has detrimental effect
Primary Outcomes
 AF symptom burden: AFib Severity Scale questionnaire
 AF freedom: 7 day Holter monitoring
Secondary Outcomes
 Structural parameters: LAV and LV thickness
 Metabolic and Inflammatory profile

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Yearly Weight Trend
(N=344)
>5%WF
N=57
2-5%WF
N=68
<2%WF
N=54
Linear
Weight Loss
N=141
(41%)
Weight
Fluctuation
N=179
(52%)
Linear Gain
N=24 (7%)
Effect of
Weight Loss Trend
Effect of Degree of
Weight fluctuation

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Implications of Dedicated Weight Loss Clinic
 52 patients lost >10% weight
in first year
 34/52 (66%) maintained WL
 30/34 (85%) attended WL
clinic
 18 regained weight, only 2
(11%) attended clinic
WL Clinic
35 (30%)
0
20
40
60
80
100
≥10% WL 3-9 % WL <3% WL
85%
57%
30%
WLClinic
WLClinic
WLClinic
TotalPatientsN=135
TotalPatientsN=103
TotalPatientsN=117

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Operative Procedure Metrics for Algisyl-LVR Implant

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5. Arritmias / Insuficiencia cardiaca
• AATAC Multicenter Randomized Trial: Ablation vs Amiodarone for Treatment of Persistent
Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted device
• Effectiveness of Surgical Ablation of Atrial Fibrillation during Mitral Valve Surgery: A
Randomized Clinical Trial from the Cardiothoracic Surgical Trials Network
• LEGACY Study: Long-Term Effect of Goal Directed Weight Management on an Atrial
Fibrillation Cohort: A 5-Year Follow-Up Study.
• PADN-2. Pulmonary Artery Denervation For Treatment Of Pulmonary Arterial Hypertension:
Results From A Controlled Before And After Study
• Mood HF Trial. Effects of Selective Serotonin Re-Uptake Inhibition on Mortality, Morbidity
and Mood in Depressed Heart Failure Patients
• AUGMENT–HF trial: A Prospective Comparison of Algisyl-LVR with Standard Medical
Therapy to Determine Impact on Functional Capacity and Clinical Outcomes in Patients
with Advanced Heart Failure.
• Baroreflex Activation therapy for the Treatment of Heart Failure with a Reduced Ejection
Fraction

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Target drugs:
5’-PDE
Prostacyclin
ET-receptor antagonists
PADN-2 Study: Pulmonary Artery Denervation For Treatment Of Pulmonary
Arterial Hypertension: Results From A Controlled Before And After Study

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Clinical events at 6-month follow-up

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Conclusion: Pulmonary Artery Denervation treatment was
associated with significant improvement of 6 MWT and less
PAH-related event
En pacientes con Hipertensión arterial Pulmonar, el tratamiento de
denervación de la arteria pulmonar se asocia con una mejoría
significativa de la capacidad funcional medida con el test de 6 MWT
y menos eventos adversos relacionado con la propia HAP

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CTSN Surgical AF Ablation Trial Design
Excluded (n=3242)
Enrollment
Allocated to MVS + Ablation (n=133)
• Pulmonary Vein Isolation (PVI) (n=67)
• Biatrial Maze (n=66)
Allocated to MVS Alone (n=127)
Allocation
• Withdrawal or lost to follow-up (n=8)
• Death before month 12 (n=9)
• Withdrawal or lost to follow-up (n=10)
• Death before month 12 (n=11)
Follow-Up
Primary Endpoint Analysis (n=133)
• Primary Endpoint Data (n=106)
• 6 & 12 Month Holter (n=96)
• Died (n=9)
• Underwent Ablation (n=1)
• Imputed (n=27)
Primary Endpoint Analysis (n=127)
• Primary Endpoint Data (n=102)
• 6 & 12 Month Holter (n=88)
• Died (n=11)
• Underwent Ablation (n=3)
• Imputed (n=25)
Analysis
Randomized (n=260)
Assessed for Eligibility
(n=3502)

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Freedom from AF at both 6 and 12
months by 3-day Holter monitor
Pts who died before 12 month
assessment or had subsequent
ablation were considered
treatment failures
Primary endpoint
• Mortality
• MACCE
• Quality of life
• Serious adverse events
Secondary endpoint

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AF Freedom: Drug & Ablation-Free
P<0.001
13%
22%
Without AAD
or ablation
46%46%

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Impact on Risk Factors

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 NYHA Functional Class III
 Left ventricular ejection fraction ≤ 35%
 Six-minute hall walk distance 150 - 400 m
 On stable optimal medical therapy for at least 4 weeks prior
to baseline assessment
 No restriction on QRS, concomitant devices*, or AF
* ≥ 6 months of CRT therapy in patients with CRT
Key Enrollment Criteria

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Twitter
La pérdida de peso y evitar la fluctuación del peso constituyen
estrategias importantes para reducir los episodios de Fibrilación
auricular. La pérdida de peso también se asoció con una beneficiosa
remodelación estructural incluyendo reducciones significativas del
volumen de la aurícula izquierda y de la hipertrofia ventricular izquierda
En pacientes con Insuficiencia cardiaca sistólica y Fibrilación auricular
persistente, la ablación con catéter ha mostrado ser más eficaz que el
tratamiento farmacológico con amiodarona para el mantenimiento a
largo plazo del ritmo sinusal, así como se asocia a una reducción de la
mortalidad y de las hospitalizaciones
La ablación quirúrgica mediante aislamiento de las venas pulmonares
durante la cirugía de válvula mitral se relaciona con un mejor control
del ritmo cardíaco en el seguimiento a los 6 y 12 meses, en pacientes
con enfermedad valvular mitral y Fibrilación auricular persistente o de
larga duración

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En pacientes obesos con fibrilación auricular paroxística o persistente, la
pérdida de peso mantenida en el tiempo se asocia con una reducción
dosis dependiente de la carga de Fibrilación auricular y el
mantenimiento del ritmo sinusal. La pérdida de peso también se asocia
con una beneficiosa remodelación cardíaca estructural, incluyendo
reducciones significativas del volumen de la aurícula izquierda y de la
hipertrofia ventricular izquierda
Una fluctuación del peso >5% amortigua el beneficio conferido por la
pérdida de peso
Una unidad específica de obesidad favorece la implicación del
paciente y la adherencia, previniendo la ganancia y la fluctuación de
peso

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En pacientes con Insuficiencia cardiaca sistólica sintomática y
depresión mayor, el tratamiento con Escitalopram no mejoró los
síntomas depresivos y fue similar al placebo en términos de
mortalidad y hospitalización en el seguimiento
Among patients with mitral valve disease and persistent atrial fibrillation, mitral
valve surgery plus atrial fibrillation ablation was effective at improving freedom
from atrial fibrillation at 6 and 12 months. There was no difference between
ablation techniques on freedom from atrial fibrillation. Major adverse cardiac
and cerebrovascular events were similar between the groups.
La cirugía de la válvula mitral asociada a la ablación quirúrgica de la
fibrilación auricular es eficaz para conseguir un mejor control del ritmo
cardíaco, aumentando la proporción de pacientes sin fibrilación
auricular los 6 y 12 meses de seguimiento.
Los pacientes con enfermedad valvular mitral y Fibrilación auricular
persistente sometidos a cirugía valvular p

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La Terapia de Activación de los Baroreceptores carotídeos es segura
en pacientes ICFER y mejora significativamente la clase funcional de la
NYHA, la calidad de vida, la capacidad de esfuerzo, el NT-proBNP, y
posiblemente reduzca las hospitalizaciones por insuficiencia cardiaca
La administración de Algisyl intramiocárdico en pacientes con
insuficiencia cardiaca avanzada es segura, con una morbimortalidad
aceptable. El tratamiento con Algisyl proporcionó una mejoría
sintomática y de la capacidad en la funcional del corazón en
comparación con los pacientes en el grupo de control.
La evaluación inicial de los eventos adversos cardiovasculares mayores
a los 6 meses sugieren un potencial impacto favorable en la reducción
de la hospitalización por IC en los pacientes tratados con Algisyl

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Conclusions: This multicenter randomized study shows that
catheter ablation of Persistent AF is superior to Amiodarone
in achieving freedom from AF at long term follow up and
reducing hospitalization and mortality in patients with heart
failure.

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Conclusions: Surgical ablation improves rhythm control in
mitral valve patients with persistent and long-standing
persistent AF
Among patients with mitral valve disease
and persistent atrial fibrillation, mitral valve
surgery plus atrial fibrillation ablation was
effective at improving freedom from atrial
fibrillation at 6 and 12 months. There was no
difference between ablation techniques
on freedom from atrial fibrillation. Major
adverse cardiac and cerebrovascular
events were similar between the groups.

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CONCLUSIONS
Sustained weight loss is associated with dose dependent
reduction in AF burden and maintenance of sinus rhythm
>5% Weight fluctuation dampens the benefit conferred by
weight loss
A dedicated clinic improves patient engagement, promoting
treatment adherence, preventing weight regain and
fluctuation
Simultaneous online publication on 16 March 2015
LEGACY Study:

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MOOD-HF Trial
Conclusions: MOOD-HF is the first larger-scale RCT on long-term
efficacy and safety of an SSRI in systolic heart failure patients
with co-morbid depression.
Escitalopram neither improved the composite primary outcome
(all-cause death or hospitalization), nor depression in this
population.

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Conclusions:
• Baroreflex Activation Therapy is safe in HFrEF patients
 No system- or procedure-related deaths
 Few and short-lived complications; complication rate comparable to
established HF device therapies
 No hypotension
• BAT significantly improves NYHA Class, quality of life
score, exercise capacity, NT-proBNP, and possibly the
burden of heart failure hospitalizations
Manuscript online today at JACC Heart Failure
http://heartfailure.onlinejacc.org

#PostACC15
MVS Alone
(N=127)
MVS & Ablation
(N=133)
Female –no. (%) 63 (49.6) 57 (42.9)
Age (yr) 69.4 ± 10.0 69.7 ± 10.4
NYHA Class III & IV –no. (%) 62 (49.2) 56 (42.1)
Atrial fibrillation duration –med
(IQR)
29 (3, 96) 18.5 (3, 65)
Atrial fibrillation type 28 (18.7) 24 (16.0)
Longstanding Persistent 71 (55.9) 70 (52.6)
Persistent 56 (44.1) 63 (47.4)
Anticoagulants –no. (%) 97 (76.4) 105 (79.0)
Anti-arrhythmic Drugs (Class III) 15 (11.8) 14 (10.5)
Mitral disease etiology
Organic 73 (57.5) 75 (56.4)
Functional non-ischemic 48 (37.8) 43 (32.3)
Ischemic 6 (4.7) 15 (11.3)

#PostACC15
MVS Alone
(N=127)
MVS & Ablation
(N=133)
Mitral Valve Surgery
Replacement 61 (48.4) 54 (40.6)
Repair 65 (51.6) 79 (59.4)
Concomitant Procedures
Tricuspid Valve Surgery 48 (38.1) 50 (37.6)
Aortic Valve Replacement 20 (15.9) 14 (10.5)
CABG 25 (19.8) 27 (20.3)
Cardiopulmonary Bypass Time (min)* 132.5 +51 147.8 +63.3
Cross-Clamp Time (min) 95.9 +36.3 102.9 +41.5
Operative Characteristics
*P-Value for Cardiopulmonary Bypass Time = 0.03

#PostACC15
Mortality(%)
Mortality
Months
MACCE
CompositeCardiacEndPoint(%)
Months
8.7%
6.8%
23.3%
20.5%
Major adverse cardiac or cerebrovascular events

#PostACC15
Quality of Life
MVS Alone
(N=127)
MVS & Ablation
(N=133)
P-Value
SF-12
Physical Function 45.3 ±7.9 44.3 ±9.0 0.38
Mental Function 48.5 ±6.5 48.0 ±6.3 0.56
AF Severity Scale
Daily AF –no. (%) 42 (45.2) 20 (19.8) <0.001
Life Rating (1-10, median) 8.0 (7,9) 8.0 (7,9) 0.45
NYHA Class III + IV –no. (%) 3 (2.9) 8 (7.0) 0.17

#PostACC15
1° Outcome
Time to all-cause death or hospitalization

#PostACC15
Major 2° Outcome
10- item Montgomery–Åsberg Depression Rating Scale

#PostACC15
<3% Wt Loss
N= 117
3-9% Wt Loss
N = 103
≥10% Wt Loss
N = 135 P Value
Age (years) 6111 6311 6511 0.06
Male gender, n (%) 83 (71) 65 (63) 86 (64) 0.4
Non-Paroxysmal AF, n (%) 45 (56) 46 (45) 64 (47) 0.9
BMI 32.94.8 32.74.4 33.64.7 0.2
Hypertension 90 (78) 75 (73) 109 (81) 0.3
DM/IGT, n (%) 34 (29) 28 (27) 41 (30) 0.5
Hyperlipidemia, n (%) 56 (48) 45 (44) 66 (49) 0.7
CAD, n (%) 14 (12) 12 (12) 21 (16) 0.3
AHI>30, n (%) 61 (52) 52 (50) 69 (51) 0.1
Smoker, n (%) 47 (40) 41 (40) 50 (37) 0.9
ETOH (>30g/week), n (%) 34 (29) 35 (34) 42 (31) 0.7

Arritmias/Insuficiencia cardiaca

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