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2503 Atrial Arrhythmia in Sickle Cell Anemia: A Missing Piece to Prevent Cerebrovascular Complications?

Program: Oral and Poster Abstracts
Session: 114. Sickle cell Disease, Sickle Cell Trait and Other Hemoglobinopathies, Excluding Thalassemias: Clinical and Epidemiological: Poster II
Hematology Disease Topics & Pathways:
Research, epidemiology, Clinical Research, real-world evidence, registries
Sunday, December 10, 2023, 6:00 PM-8:00 PM

Thomas d'Humières, MD1*, Zineb Sadraoui2*, Laurent Savale, MD, PhD3*, Laurent Boyer, MD, PhD4*, Gonzalo De Luna, MD5*, Anoosha Habibi, MD6, Laurent Messonier7*, David Calvet, MD, PhD8*, Nicolas Lellouche, MD, PhD9*, Geneviève Derumeaux, MD, PhD10* and Pablo Bartolucci, MD, PhD5*

1Physiology Department, FHU SENEC, INSERM IMRB U955, Henri-Mondor University Hospital- UPEC, AP-HP, Creteil, France
2Physiology, Henri Mondor teaching hospital, Créteil, France
3Kremblin Bicêtre teaching hospital, Le Kremlin Bicêtre, FRA
4CHU Henri Mondor, Créteil, France
5Sickle Cell Referral Center, Henri-Mondor University Hospital- UPEC, AP-HP, Creteil, France
6Sickle Cell Referral Center, Henri-Mondor University Hospital- UPEC, AP-HP, Creteil Cedex, FRA
7Inter-university Laboratory of Human Movement Sciences EA 7424, Université Savoie Mont Blanc,, Chambéry, France
8Centre Hospitalier Sainte-Anne, Paris, France
9Cardiology Department, Henri Mondor Hospital, Assistance Publique HôPitau, CréTeil, FRA
10CHU Henri Mondor, FHU SENEC, Créteil, France

Background: Although Sickle Cell anemia (SCA) patients carries an increased risk of stroke and an important left atrial (LA) remodeling, the reality of atrial arrythmia (AA) has never been prospectively assessed.

Purpose: The aim of this study was to identify the prevalence and predictors of atrial arrhythmia in SCA patients among Drepacoeur registry.

Methods: From January 2019 to November 2022, consecutive adult patients with SCA were referred to the physiology department to specifically analyze cardiac function and were prospectively included. They underwent a 24-hour electrocardiogram monitoring (ECG-Holter), transthoracic echocardiography, and laboratory tests on the same day. The primary end point was the occurrence of AA, defined by the presence of excessive supraventricular ectopic activity (ESVEA) on ECG-holter (i.e. >720 premature atrial contractions [PACs] or any run ≥ 20 PACs), recent history of paroxysmal atrial fibrillation (AFib), of persistant AFib.

Results: Overall, 130 patients were included. Mean age was 45±12 years, 48% were male. AA was observed in 34 (26%) patients (17 with more than 720 PACs/day, 6 with at least a run ≥ 20 PACs, 11 with recent history of paroxysmal AFib and 5 with persistant AFib). Ageing (52±9 vs. 42±12 years, P=0,004), LA dilation (LAVi, 71±24 vs. 52±14 ml/m², P<0.001) and history of stroke without underlying cerebral vasculopathy (23% vs. 7%, P=0.04) were independently associated with AA. Age and LAVi correlated with PAC load on ECG-holter (R=0,56, P<0,001 and R=0,33, P<0.001 respectively). Interestingly n age over 47 years or a LAVi >55ml/m² could predict AA with a positive prective value of 33% and a negative one of 92%.

Conclusion: Atrial arrythmia is common in adult SCA patients and is associated with ageing, LA remodeling and considerably increases the risk of ischemic stroke. This study provides tools for early detection of AA and prevent cardiac and cerebrovascular dramatic complications in this highly vulnerable population.

Disclosures: De Luna: VERTEX: Consultancy; GBT: Consultancy; Pfizer: Other: Principal Investigator HEMOPROVE trial. Habibi: GBT: Consultancy; Add Medica: Honoraria; novartis: Consultancy; Vertex: Consultancy. Bartolucci: Bluebird: Consultancy; Roche: Consultancy; Addmedica: Consultancy, Membership on an entity's Board of Directors or advisory committees; GBT: Consultancy; Emmaus: Consultancy; Jazz Pharma: Consultancy; INNOVHEM: Current equity holder in private company; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees.

*signifies non-member of ASH