PMID- 23348529
OWN - NLM
STAT- MEDLINE
DCOM- 20130417
LR  - 20130125
IS  - 1897-4279 (Electronic)
IS  - 0022-9032 (Linking)
VI  - 71
IP  - 1
DP  - 2013
TI  - Catheter ablation of atrial fibrillation in patients with hypertrophic 
      cardiomyopathy: atrial fibrillation type determines the success rate.
PG  - 17-24
AB  - BACKGROUND: Atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy 
      (HCM) is generally associated with deterioration of the clinical status, 
      functional capacity, and quality of life. It is also an independent risk factor 
      for stroke and death. Studies evaluating the effectiveness of AF ablation in this 
      cohort are relatively scant, have included relatively few patients, and their 
      results are somewhat conflicting. Thus, the aim of this study was to assess the 
      safety and efficacy of catheter ablation of AF in patients with HCM. METHODS: 
      Thirty patients (10 females; mean age 48.7 +/- 11 years) with drug-refractory 
      paroxysmal (n = 14), persistent (n = 7), or long-persistent (> 1 year; n = 9) AF 
      were prospectively recruited into the study. Eleven patients were in New York 
      Heart Association (NYHA) class I, 13 patients were in NYHA class II, and 6 
      patients were in NYHA class III. Mean atrial volume was 180 +/- 47 mL, 
      interventricular septum thickness was 20.5 +/- 6.3 mm, and left atrial area was 
      29.8 +/- 6.2 cm2. Ablation protocol was adjusted to the clinical and 
      electrophysiological status of the patients. Pulmonary vein isolation and 
      bidirectional cavo-tricuspid isthmus block were performed in all patients. In 
      addition, left atrial linear lesions were created and complex fragmented atrial 
      potentials were ablated in patients with persistent and long-persistent AF, as 
      well as during repeated procedures. RESULTS: At 12 months, stable sinus rhythm 
      (SR) was present in 16 (53%) patients, significantly more frequently in patients 
      with paroxysmal AF (71% in SR) compared to those with persistent (57.1% in SR) or 
      long-persistent (22% in SR) AF. A significant reduction of AF burden was observed 
      in 85.7% of patients with paroxysmal AF, 71.4% of patients with persistent AF, 
      and 55.5% of patients with long-persistent AF. Single procedure success rate was 
      33% (10 patients), and repeat ablation procedures were performed in 13 patients. 
      No periprocedural complications occurred. Thromboembolic events were noted in 2 
      patients with arrhythmia recurrence during the follow-up, including stroke in 1 
      patient and peripheral embolism in the other patient. In both these patients, 
      heart failure worsening was observed during these events, and anticoagulation was 
      inadequate in one of them. Five of 16 patients in whom stable SR was observed 
      during the follow-up were off antiarrhythmic drug therapy at final evaluation. In 
      the other 6 patients, antiarrhythmic drug therapy was continued due to 
      ventricular arrhythmias. Successfully treated patients more often had paroxysmal 
      AF (successful ablation: paroxysmal AF in 10 of 16 patients; unsuccessful 
      ablation: paroxysmal AF in 4 of 14 patients; p = 0.009) and were younger (45 +/- 
      11.5 years vs. 52.6 +/- 9.2 years; p = 0.046). In addition, a trend toward a 
      reduced need for cardioversion at the end of the procedure was also observed in 
      these patients (3 patients in the successful ablation group vs. 8 patients in the 
      unsuccessful ablation group; p = 0.056). In multivariate regression analysis, 
      paroxysmal AF was the only independent predictor of a successful outcome. 
      CONCLUSIONS: Catheter ablation of AF in patients with HCM is an effective and 
      safe therapeutic option, particularly in patients with paroxysmal AF. 
      Effectiveness of ablation is significantly smaller in patients with persistent AF 
      and even more so in those with long-persistent AF. Repeated procedures were often 
      necessary. Continued antiarrhythmic drug therapy is often required due to a 
      significant degree of atrial remodelling.
FAU - Derejko, Pawel
AU  - Derejko P
AD  - Institute of Cardiology, Warsaw, Poland. pderejko@yahoo.com.
FAU - Polanska, Magdalena
AU  - Polanska M
FAU - Chojnowska, Lidia
AU  - Chojnowska L
FAU - Michalowska, Ilona
AU  - Michalowska I
FAU - Wojcik, Anna
AU  - Wojcik A
FAU - Piotrowicz, Ewa
AU  - Piotrowicz E
FAU - Lech, Agnieszka
AU  - Lech A
FAU - Klopotowski, Mariusz
AU  - Klopotowski M
FAU - Baranowski, Rafal
AU  - Baranowski R
FAU - Przybylski, Andrzej
AU  - Przybylski A
FAU - Bilinska, Maria
AU  - Bilinska M
FAU - Sierpinski, Radoslaw
AU  - Sierpinski R
FAU - Walczak, Franciszek
AU  - Walczak F
FAU - Szumowski, Lukasz
AU  - Szumowski L
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - Poland
TA  - Kardiol Pol
JT  - Kardiologia polska
JID - 0376352
RN  - 0 (Anti-Arrhythmia Agents)
SB  - IM
MH  - Anti-Arrhythmia Agents/therapeutic use
MH  - Atrial Fibrillation/classification/drug therapy/etiology/*surgery
MH  - Cardiac Volume
MH  - Cardiomyopathy, Hypertrophic/*complications
MH  - Catheter Ablation/*methods
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Reoperation
MH  - Treatment Outcome
EDAT- 2013/01/26 06:00
MHDA- 2013/04/19 06:00
CRDT- 2013/01/26 06:00
PHST- 2013/01/22 00:00 [received]
PHST- 2013/01/22 00:00 [accepted]
PHST- 2013/01/26 06:00 [entrez]
PHST- 2013/01/26 06:00 [pubmed]
PHST- 2013/04/19 06:00 [medline]
AID - VM/OJS/KP/7607 [pii]
PST - ppublish
SO  - Kardiol Pol. 2013;71(1):17-24.