Results of catheter ablation of atrial fibrillation in hypertrophied hearts – Comparison between primary and secondary hypertrophy

Abstract

Radiofrequency catheter ablation (RFCA) was successful in restoring long-term sinus rhythm in patients with LVH due to HCM and due to secondary etiology. However, patients with HCM needed more RFCA procedures and frequently additional antiarrhythmic drug therapy in order to maintain sinus rhythm.

Catheter ablation for atrial fibrillation in hypertrophic cardiomyopathy: a systematic review and meta-analysis

“…Of these, 177 were excluded as they were either duplicates or deemed unsuitable for the purpose of the meta-analysis (editorials, letters, reviews or case reports). The remaining 32 studies were carefully screened and after analysis of their abstracts and/or full-text only [14][15][16][17][18][19][20][21][22][23][24][25][26][27] (one was a conference abstract 22 ) were considered adequate for inclusion in the systematic review (figure 1). Of these, only six studies, 16 19 22-25 provided enough details to be included in the meta-analysis.…”

“…Figure 2 illustrates freedom from arrhythmia in patients with HCM and controls. Control patients had no structural heart disease, except for left ventricular hypertrophy secondary to systemic hypertension in Müssigbrodt et al, 25 21 or these were used in only a minority of patients. 22 However, in the remaining studies, antiarrhythmic agents were needed for optimisation of the rhythm control strategy in >25%-50% of patients with HCM.…”

“…17 18 24-27 In two studies, persistent AF was also associated with worse procedural outcomes (OR=7.7, 95% CI 1.13 to 50, p=0.02 20 and OR=2.58, 95% CI 1.11 to 6.05, p=0.028 21 ). Other predictors of relapse were identified separately in single studies: age and New York Heart Association (NYHA) class, 18 left atrial pressure and left ventricle (LV) outflow tract obstruction, 24 AF duration in months and E/E 0 , 25 and corrected QT interval (QTc) duration 27 (table 4).…”

Catheter Ablation of Atrial Fibrillation in Chronic Heart Failure: A Contemporary Review

“…Fourteen studies were finally selected, with one study in particular including patients with tachycardiomyopathy (TCM), eight studies including patients with hypertrophic cardiomyopathy (HCM), and five studies including patients with valvular cardiomyopathy. [43][44][45][46][47][48][49][50][51][52][53][54][55][56] Observational studies. As detailed in Table 1, observational studies included 1,504 patients.…”

“…Concerning AF ablation outcome, eight observational studies have been conducted among HCM patients. [44][45][46][47][48][49][50][51] Consistently, all studies reported a very limited efficacy after a single ablation procedure. However, about half of the patients underwent repeated procedures, raising the efficacy up to 70% to 80%; in this respect, the prevalence of extensive LA or biatrial ablation, including linear lesions and CFAEs, was significantly higher as compared with more ''classical'' CHF patients ( Figure 1).…”