Catheter ablation of atrial fibrillation in patients with hypertrophic cardiomyopathy: a European observational multicentre study

Abstract

Aims Atrial fibrillation (AF) is common in hypertrophic cardiomyopathy (HCM). Data on the efficacy of catheter ablation of AF in HCM patients are sparse. Methods and results Observational multicentre study in 137 HCM patients (mean age 55.0 ± 13.4, 29.1% female; 225 ablation procedures). We investigated (i) the efficacy of catheter ablation for AF beyond the initial 12 months; (ii) the available risk scores, stratification schemes and genotype as potential predictors of arrhythmia relapse, and (iii) the impact of cryoballoon vs. radiofrequency in procedural outcomes. Mean follow-up was 43.8 ± 37.0 months. Recurrences after the initial 12-month period post-ablation were frequent, and 24 months after the index procedure, nearly all patients with persistent AF had relapsed, and only 40% of those with paroxysmal AF remained free from arrhythmia recurrence. The APPLE score demonstrated a modest discriminative capacity for AF relapse post-ablation (c-statistic 0.63, 95% CI 0.52–0.75; P = 0.022), while the risk stratification schemes for sudden death did not. On multivariable analysis, left atrium diameter and LV apical aneurysm were independent predictors of recurrence. Fifty-eight patients were genotyped; arrhythmia-free survival was similar among subjects with different gene mutations. Rate of procedural complications was high (9.3%), although reducing over time. Outcome for cryoballoon and radiofrequency ablation was comparable. Conclusion Very late AF relapses post-ablation is common in HCM patients, especially in those with persistent AF. Left atrium size, LV apical aneurysm, and the APPLE score might contribute to identify subjects at higher risk of arrhythmia recurrence. First-time cryoballoon is comparable with radiofrequency ablation.

Catheter Ablation for Atrial Fibrillation in Structural Heart Disease: A Review

“…Besides the possible presence of gaps in the isolation lesions set, two interesting hypotheses are proposed to explain the higher recurrence rate seen in HCM patients: the response of hypertrophic tissue to RF is different from that of normal myocardial tissue and non-PV foci are more frequent in HCM patients. The former might be the cause of PV stenosis, which occurs more often in these patients [ 58 ]. The latter is supported by the high frequency of post-ablation non-AF atrial tachycardias (38.4%) that have either macro-reentry or localized reentry as an underlying mechanism [ 59 ].…”

Catheter ablation of atrial fibrillation in hypertrophic cardiomyopathy: A proportional meta-analysis and systematic review of single-arm studies

“…We identified 19 studies with 1183 patients for our final analysis. 1 , 10 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 All selected studies were observational (12 prospective and 7 retrospective), and single arm in design ( Figure 1 ). Mean age across studies was 55 years, and women comprised 29%.…”

Characteristics of left atrial remodeling in patients with atrial fibrillation and hypertrophic cardiomyopathy in comparison to patients without hypertrophy

“…Our findings supplement previous studies and emphasize the association between HCM and LA remodeling 14 . LA size and fibrosis are known predictors of recurrences after CA 14 , 15 . PV reconnection has been shown to be very frequent in the context of HCM resulting in modest long-term success 16 .…”