Catheter ablation of atrial fibrillation in hypertrophic cardiomyopathy long-term outcomes and mechanisms of arrhythmia recurrence

Pasquale Santangeli, Luigi Di Biase, Sakis Themistoclakis, Antonio Raviele, Robert A. Schweikert, Dhanunjaya Lakkireddy, Prasant Mohanty, Rong Bai, Sanghamitra Mohanty, Agnes Pump, Salwa Beheiry, Richard Hongo, Javier E. Sanchez, G. Joseph Gallinghouse, Rodney Horton, Antonio Dello Russo, Michela Casella, Gaetano Fassini, Claude S. Elayi, J. David BurkhardtClaudio Tondo, Andrea Natale

Research output: Contribution to journalArticle

30 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1089-1094
Number of pages6
JournalCirculation: Arrhythmia and Electrophysiology
Volume6
Issue number6
DOIs
StatePublished - Dec 1 2013

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Keywords

  • Atrial fibrillation
  • Cardiomyopathies
  • Cardiomyopathy
  • Catheter ablation
  • Hypertrophic

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Santangeli, P., Biase, L. D., Themistoclakis, S., Raviele, A., Schweikert, R. A., Lakkireddy, D., Mohanty, P., Bai, R., Mohanty, S., Pump, A., Beheiry, S., Hongo, R., Sanchez, J. E., Gallinghouse, G. J., Horton, R., Russo, A. D., Casella, M., Fassini, G., Elayi, C. S., ... Natale, A. (2013). Catheter ablation of atrial fibrillation in hypertrophic cardiomyopathy long-term outcomes and mechanisms of arrhythmia recurrence. Circulation: Arrhythmia and Electrophysiology, 6(6), 1089-1094. https://doi.org/10.1161/CIRCEP.113.000339