Clinical Significance of Postoperative Atrial Fibrillation in Hypertrophic Cardiomyopathy Patients Undergoing Septal Myectomy

Bataiosu, Roxana D.; Hoss, Sara El; Scolari, Fernando Luís; Cooper, Craig; Tsoi, Melissa; Brahmbhatt, Darshan H.; Billia, Filio; Lee, Deacon Z.J.; Chan, Raymond H.; Ha, Andrew C.T.; Maron, Barry J.; Rowin, Ethan J.; Maron, Martin S.; Ralph-Edwards, Anthony; Rakowski, Harry; Adler, Arnon

doi:10.1016/j.cjca.2023.06.415

Cited by 5 publications

(3 citation statements)

References 16 publications

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“…AF episodes isolated to the first 2 to 3 months after myectomy occur in ≈30% of patients. 100–102 These postoperative AF episodes do not appear to be associated with long-term risk for embolic stroke, suggesting that routine long-term anticoagulation is not necessary after the initial postoperative period for these patients. 100 However, postoperative AF does predict future AF.…”

Section: Rhythm Controlmentioning

confidence: 88%

“…100–102 These postoperative AF episodes do not appear to be associated with long-term risk for embolic stroke, suggesting that routine long-term anticoagulation is not necessary after the initial postoperative period for these patients. 100 However, postoperative AF does predict future AF. 100 Some centers have administered amiodarone prophylactically after myectomy to prevent these episodes, a strategy that decreases postoperative AF risk, but does not reduce the length of hospitalization 101…”

Section: Rhythm Controlmentioning

confidence: 88%

“…100 However, postoperative AF does predict future AF. 100 Some centers have administered amiodarone prophylactically after myectomy to prevent these episodes, a strategy that decreases postoperative AF risk, but does not reduce the length of hospitalization 101…”

Section: Postoperative Afmentioning

confidence: 99%

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Evolving Contemporary Management of Atrial Fibrillation in Hypertrophic Cardiomyopathy

Rowin,

Link,

Maron

et al. 2023

Circulation

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Atrial fibrillation (AF) is the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM) with clinical and subclinical episodes occurring in nearly one-half of patients. AF in HCM historically has been characterized as a decisive disease complication associated with substantial risk for thromboembolic stroke and increased morbidity and mortality. However, there have been many advances in treatment strategy resulting in improved outcomes for this patient group. For example, stroke risk in HCM has been greatly reduced by using systemic oral anticoagulation initiated after the first clinical (symptomatic) AF episode, usually with preference given to direct anticoagulants over warfarin. In contrast, stroke risk scoring systems (such as CHA 2 DS 2 -VASc score) are not informative in HCM given the substantial potential for stroke events in patients with low scores, and therefore should not be used for anticoagulation decisions in this disease. A novel risk score specifically designed for HCM (HCM-AF score) can reliably identify most patients with HCM at risk for future AF. Although a strategy focused on controlling ventricular rate is effective in asymptomatic (or minimally symptomatic) patients with AF, restoring and maintaining sinus rhythm is required for most patients with marked AF symptom burden and impaired quality of life. Several antiarrhythmic drugs such as sotalol, disopyramide, and amiodarone, can be effective in suppressing AF episodes; albeit safe, long-term efficacy is supported by only limited data. Catheter AF ablation has emerged as an important treatment option for some patients, although freedom from AF after a single ablation is relatively low (35% at 3 years), multiple ablations and the concomitant use of antiarrhythmic drugs can control AF with more than two-thirds of patients maintaining sinus rhythm at 5 years. Surgical AF ablation with biatrial Cox-Maze IV performed as an adjunctive procedure during myectomy can reduce symptomatic AF episodes (70% of patients free from AF at 5 years). For the vast majority of patients who have HCM with AF, the implementation of contemporary therapies has allowed for improved quality of life and low HCM-related mortality.

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Section: Rhythm Controlmentioning

confidence: 88%