136-28: Contemporary patterns of rhythm control in patients with non-valvular atrial fibrillation in the Balkan Region: Insight from the BALKAN-AF Survey

Abstract

Background: Contemporary atrial fibrillation (AF) registries provide important insights into AF management in real-world clinical practice, but most Balkan countries (a region of .50 million inhabitants) are largely underrepresented in these registries.We prospectively investigated real-world patterns of non-valvular AF management in Balkan countries, and here we report the results pertinent to rhythm control strategy. Methods: A 14-week (December 2014-February 2015) prospective, multicentre survey of consecutive AF patients seen by cardiologists or internal medicine specialists in Albania, Bosnia & Herzegovina, Bulgaria, Croatia, Montenegro, Romania and Serbia was designed and conducted by the Serbian AF Association (SAFA), a nonprofit multidisciplinary association of expert physicians involved in AF management and AF research. Results: Of 2712 consecutive patients (mean age 69.1 + 10.9 years, female 44.0%), AF was newly-diagnosed in 632 patients (23.3%) who were younger (67.5 + 12.1 vs. 69.6 + 10.5), more symptomatic (mean EHRA score 2.4 + 0.8 vs. 2.1 + 0.8), with higher heart rate (103.4 + 33.4 vs. 87.4 + 25.5 bpm), lower mean NYHA class (1.5 + 0.9 vs. 1.8 + 1.0), smaller left atrial size (43.2 + 7.2 vs. 46.5 + 7.9 mm) and less cardiovascular co-morbidity (e.g., hypertension, myocardial infarction, etc.) compared to patients with previous AF history (all p , 0.001). Cigarette smoking and excessive alcohol use were more frequent among newly-diagnosed AF patients (n = 117, 18.5% vs. n = 222, 10.9% and n = 38, 6.0% vs. n = 72, 3.5%, respectively), both p , 0.001. Rhythm control was more often used in newly-diagnosed AF patients (n = 322, 50.9% vs. n = 567, 27.3%, p , 0.001; Odds Ratio 2.77; 95%CI, 2.31-3.33, p , 0.001). At enrolment, 65 patients (2.4%) were scheduled for AF ablation, mostly patients with previous AF history (n = 60, 2.9%). External electrical cardioversion was planned in total of 53 patients (2.0%), more commonly in newly-diagnosed AF patients (n = 24, 3.9%) as compared to patients with previous AF history (n = 29, 1.4%), p , 0.001. Amiodarone was the most frequently used antiarrhythmic drug (n = 444, 49.9%), particularly in newly-diagnosed patients (n = 177, 55.0% vs. n = 267, 47.1%, p = 0.026), whilst propafenone was more frequently used in patients with previous AF history (n = 162, 28.6% vs. n = 57, 17.7%, p , 0.001). Sotalol was used in total of 18 patients (2.0%), whilst flecainide and dronedarone were used only rarely (0.4% and 0.2%, respectively). There was no significant association between AF symptoms and rhythm control (Odds Ratio 0.85; 95%CI, 0.70-1.03, p = 0.104), but the choice of rhythm control strategy was less likely with increasing patient age (Odds Ratio 0.957; 95%CI, 0.949-0.964, p , 0.001). Conclusion: Our survey showed that in Balkan countries rhythm control strategy was commonly used in younger patients with newly-diagnosed non-valvular AF regardless of AF-related symptoms. Pharmacological rhythm control was used more frequently than electrical cardioversion or AF ablation. Overall, amiodarone and propafenone were used much more often than other antiarrhythmic drugs. Interestingly, amiodarone was more often used in patients with newly-diagnosed AF, whilst propafenone was more frequently used in patients with a history of previous AF.