TY - JOUR
T1 - Catheter ablation of atrial fibrillation in hypertrophic cardiomyopathy long-term outcomes and mechanisms of arrhythmia recurrence
AU - Santangeli, Pasquale
AU - Biase, Luigi Di
AU - Themistoclakis, Sakis
AU - Raviele, Antonio
AU - Schweikert, Robert A.
AU - Lakkireddy, Dhanunjaya
AU - Mohanty, Prasant
AU - Bai, Rong
AU - Mohanty, Sanghamitra
AU - Pump, Agnes
AU - Beheiry, Salwa
AU - Hongo, Richard
AU - Sanchez, Javier E.
AU - Gallinghouse, G. Joseph
AU - Horton, Rodney
AU - Russo, Antonio Dello
AU - Casella, Michela
AU - Fassini, Gaetano
AU - Elayi, Claude S.
AU - Burkhardt, J. David
AU - Tondo, Claudio
AU - Natale, Andrea
PY - 2013/12
Y1 - 2013/12
N2 - Background-Pulmonary vein (PV) antrum isolation in patients with hypertrophic cardiomyopathy and atrial fibrillation (AF) has been reported to have satisfactory results at the mid- and short-term follow-up. We determined the outcomes at the long-term follow-up of PV antrum isolation in these patients. Methods and Results-We enrolled 43 patients with hypertrophic cardiomyopathy and AF (28% paroxysmal AF). PV antrum isolation (paroxysmal AF) and posterior wall isolation with complex fractionated atrial electrogram ablation (persistent and longstanding persistent AF) were the end points at the time of the index procedure and for repeat procedures during the first year of follow-up. In case of recurrent arrhythmia >1 year, high-dose isoproterenol challenge was used to disclose non-PV trigger sites. During the first year, the success rate reached 91% (mean of 1.6 procedures). After a median follow-up of 42 months (range, 38-48 months), 49% of the patients remained free from AF/atrial tachycardia. All patients underwent an additional procedure. PV antrum and posterior wall remained isolated in 82% of the cases, and extra-PV triggers were documented in all patients and targeted for ablation. After a median follow-up of 15 months (range, 8-19 months) subsequent to the last procedure, 94% of the patients remained free from AF/atrial tachycardia off antiarrhythmic drugs. Conclusions-PV isolation in patients with hypertrophic cardiomyopathy is feasible and safe, although is not effective in preventing late (=1 year) AF recurrences in ̃50% of patients. Non-PV triggers seem to be responsible of late recurrences, which supports the appropriateness of a more extensive ablation beyond PV isolation to improve the long-term arrhythmiafree survival.
AB - Background-Pulmonary vein (PV) antrum isolation in patients with hypertrophic cardiomyopathy and atrial fibrillation (AF) has been reported to have satisfactory results at the mid- and short-term follow-up. We determined the outcomes at the long-term follow-up of PV antrum isolation in these patients. Methods and Results-We enrolled 43 patients with hypertrophic cardiomyopathy and AF (28% paroxysmal AF). PV antrum isolation (paroxysmal AF) and posterior wall isolation with complex fractionated atrial electrogram ablation (persistent and longstanding persistent AF) were the end points at the time of the index procedure and for repeat procedures during the first year of follow-up. In case of recurrent arrhythmia >1 year, high-dose isoproterenol challenge was used to disclose non-PV trigger sites. During the first year, the success rate reached 91% (mean of 1.6 procedures). After a median follow-up of 42 months (range, 38-48 months), 49% of the patients remained free from AF/atrial tachycardia. All patients underwent an additional procedure. PV antrum and posterior wall remained isolated in 82% of the cases, and extra-PV triggers were documented in all patients and targeted for ablation. After a median follow-up of 15 months (range, 8-19 months) subsequent to the last procedure, 94% of the patients remained free from AF/atrial tachycardia off antiarrhythmic drugs. Conclusions-PV isolation in patients with hypertrophic cardiomyopathy is feasible and safe, although is not effective in preventing late (=1 year) AF recurrences in ̃50% of patients. Non-PV triggers seem to be responsible of late recurrences, which supports the appropriateness of a more extensive ablation beyond PV isolation to improve the long-term arrhythmiafree survival.
KW - Atrial fibrillation
KW - Cardiomyopathies
KW - Cardiomyopathy
KW - Catheter ablation
KW - Hypertrophic
UR - http://www.scopus.com/inward/record.url?scp=84892176541&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84892176541&partnerID=8YFLogxK
U2 - 10.1161/CIRCEP.113.000339
DO - 10.1161/CIRCEP.113.000339
M3 - Article
AN - SCOPUS:84892176541
SN - 1941-3149
VL - 6
SP - 1089
EP - 1094
JO - Circulation: Arrhythmia and Electrophysiology
JF - Circulation: Arrhythmia and Electrophysiology
IS - 6
ER -