Ablation of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy: Treatment Strategy, Characteristics of Consecutive Atrial Tachycardia and Long‐Term Outcome

Abstract

Background Atrial fibrillation (AF) is common in patients with hypertrophic cardiomyopathy (HCM) and is associated with a deterioration of clinical status. Ablation of symptomatic AF is an established therapy, but in HCM, the characteristics of recurrent atrial arrhythmias and the long‐term outcome are uncertain. Methods and Results Sixty‐five patients with HCM (aged 64.5±9.9 years, 42 [64.6%] men) underwent AF ablation. The ablation strategy included pulmonary vein isolation in all patients and ablation of complex fractionated atrial electrograms or subsequent atrial tachycardias (AT) if appropriate. Paroxysmal, persistent AF, and a primary AT was present in 13 (20.0%), 51 (78.5%), and 1 (1.5%) patients, respectively. Twenty‐five (38.4%) patients developed AT with a total number of 54 ATs. Stable AT was observed in 15 (23.1%) and unstable AT in 10 (15.3%) patients. The mechanism was characterized as a macroreentry in 37 (68.5%), as a localized reentry in 12 (22.2%), a focal mechanism in 1 (1.9%), and not classified in 4 (7.4%) ATs. After 1.9±1.2 ablation procedures and a follow‐up of 48.1±32.5 months, freedom of AF/AT recurrences was demonstrated in 60.0% of patients. No recurrences occurred in 84.6% and 52.9% of patients with paroxysmal and persistent AF, respectively ( P <0.01). Antiarrhythmic drug therapy was maintained in 24 (36.9%) patients. Conclusions AF ablation in patients with HCM is effective for long‐term rhythm control, and especially patients with paroxysmal AF undergoing pulmonary vein isolation have a good clinical outcome. ATs after AF ablation are frequently observed in HCM. Freedom of atrial arrhythmia is achieved by persistent AF ablation in a reasonable number of patients even though the use of antiarrhythmic drug therapy remains high.

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

“…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 ]. This may be explained by the extensive structural alterations seen in HCM atria and may be a reason to pursue a non-PVI-only ablation strategy [ 60 ].…”

Acute myocardial infarction occurring after hypertrophic obstructive cardiomyopathy with paroxysmal atrial fibrillation: a case report

“…RFCA can decrease atrial arrhythmia and thromboembolic events, maintain long-term sinus rhythm, and improve the quality of life in patients with HCM complicated by paroxysmal AF. [17][18][19][20][21] Therefore, RFCA may be an effective therapeutic strategy for patients with symptomatic drug-refractory AF. Our patient was admitted to our hospital with a diagnosis of AMI in a critical condition.…”

Electrophysiological and Structural Remodeling of the Atria in a Mouse Model of Troponin-I Mutation Linked Hypertrophic Cardiomyopathy: Implications for Atrial Fibrillation

“…Atrial remodeling is implicated in the pathogenesis of AF and may explain the increased AF prevalence in HCM with increasing age. Pulmonary vein isolation, coupled with the targeted complex fractionated atrial electrogram ablation which may occur in areas of fibrosis, conduction slowing, or block [58], has recently been shown to be effective in maintaining long-term rhythm control in HCM patients [59]. Therefore, early modulation of the atrial electrophysiological and structural changes may represent new therapeutic approaches in the early treatment and prevention of AF in HCM.…”