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 Citations (Scopus)

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 2013

Fingerprint

Catheter Ablation
Hypertrophic Cardiomyopathy
Pulmonary Veins
Atrial Fibrillation
Cardiac Arrhythmias
Recurrence
Patient Isolation
Tachycardia
Veins
Cardiac Electrophysiologic Techniques
Anti-Arrhythmia Agents
Isoproterenol
Survival

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Catheter ablation of atrial fibrillation in hypertrophic cardiomyopathy long-term outcomes and mechanisms of arrhythmia recurrence. / Santangeli, Pasquale; Di Biase, Luigi; Themistoclakis, Sakis; Raviele, Antonio; Schweikert, Robert A.; Lakkireddy, Dhanunjaya; Mohanty, Prasant; Bai, Rong; Mohanty, Sanghamitra; Pump, Agnes; Beheiry, Salwa; Hongo, Richard; Sanchez, Javier E.; Gallinghouse, G. Joseph; Horton, Rodney; Russo, Antonio Dello; Casella, Michela; Fassini, Gaetano; Elayi, Claude S.; Burkhardt, J. David; Tondo, Claudio; Natale, Andrea.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 6, No. 6, 12.2013, p. 1089-1094.

Research output: Contribution to journalArticle

Santangeli, P, Di Biase, L, Themistoclakis, S, Raviele, A, Schweikert, RA, Lakkireddy, D, Mohanty, P, Bai, R, Mohanty, S, Pump, A, Beheiry, S, Hongo, R, Sanchez, JE, Gallinghouse, GJ, Horton, R, Russo, AD, Casella, M, Fassini, G, Elayi, CS, Burkhardt, JD, Tondo, C & Natale, A 2013, 'Catheter ablation of atrial fibrillation in hypertrophic cardiomyopathy long-term outcomes and mechanisms of arrhythmia recurrence', Circulation: Arrhythmia and Electrophysiology, vol. 6, no. 6, pp. 1089-1094. https://doi.org/10.1161/CIRCEP.113.000339
Santangeli, Pasquale ; Di Biase, Luigi ; Themistoclakis, Sakis ; Raviele, Antonio ; Schweikert, Robert A. ; Lakkireddy, Dhanunjaya ; Mohanty, Prasant ; Bai, Rong ; Mohanty, Sanghamitra ; Pump, Agnes ; Beheiry, Salwa ; Hongo, Richard ; Sanchez, Javier E. ; Gallinghouse, G. Joseph ; Horton, Rodney ; Russo, Antonio Dello ; Casella, Michela ; Fassini, Gaetano ; Elayi, Claude S. ; Burkhardt, J. David ; Tondo, Claudio ; Natale, Andrea. / Catheter ablation of atrial fibrillation in hypertrophic cardiomyopathy long-term outcomes and mechanisms of arrhythmia recurrence. In: Circulation: Arrhythmia and Electrophysiology. 2013 ; Vol. 6, No. 6. pp. 1089-1094.
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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.",
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T1 - Catheter ablation of atrial fibrillation in hypertrophic cardiomyopathy long-term outcomes and mechanisms of arrhythmia recurrence

AU - Santangeli, Pasquale

AU - Di Biase, Luigi

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

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