Background-Pulmonary vein (PV) antrum isolation in patients with hypertrophic cardiomyopathy and atrial fibrillation (AF) has been reported to have satisfactory results at the mid- and short-term follow-up. We determined the outcomes at the long-term follow-up of PV antrum isolation in these patients. Methods and Results-We enrolled 43 patients with hypertrophic cardiomyopathy and AF (28% paroxysmal AF). PV antrum isolation (paroxysmal AF) and posterior wall isolation with complex fractionated atrial electrogram ablation (persistent and longstanding persistent AF) were the end points at the time of the index procedure and for repeat procedures during the first year of follow-up. In case of recurrent arrhythmia >1 year, high-dose isoproterenol challenge was used to disclose non-PV trigger sites. During the first year, the success rate reached 91% (mean of 1.6 procedures). After a median follow-up of 42 months (range, 38-48 months), 49% of the patients remained free from AF/atrial tachycardia. All patients underwent an additional procedure. PV antrum and posterior wall remained isolated in 82% of the cases, and extra-PV triggers were documented in all patients and targeted for ablation. After a median follow-up of 15 months (range, 8-19 months) subsequent to the last procedure, 94% of the patients remained free from AF/atrial tachycardia off antiarrhythmic drugs. Conclusions-PV isolation in patients with hypertrophic cardiomyopathy is feasible and safe, although is not effective in preventing late (=1 year) AF recurrences in Ì50% of patients. Non-PV triggers seem to be responsible of late recurrences, which supports the appropriateness of a more extensive ablation beyond PV isolation to improve the long-term arrhythmiafree survival.
Catheter ablation of atrial fibrillation in hypertrophic cardiomyopathy long-term outcomes and mechanisms of arrhythmia recurrence / P. Santangeli, L.D. Biase, S. Themistoclakis, A. Raviele, R.A. Schweikert, D. Lakkireddy, P. Mohanty, R. Bai, S. Mohanty, A. Pump, S. Beheiry, R. Hongo, J.E. Sanchez, G..J. Gallinghouse, R. Horton, A.D. Russo, M. Casella, G. Fassini, C.S. Elayi, J..D. Burkhardt, C. Tondo, A. Natale. - In: CIRCULATION. ARRHYTHMIA AND ELECTROPHYSIOLOGY. - ISSN 1941-3149. - 6:6(2013), pp. 1089-1094.
|Titolo:||Catheter ablation of atrial fibrillation in hypertrophic cardiomyopathy long-term outcomes and mechanisms of arrhythmia recurrence|
|Parole Chiave:||Atrial fibrillation; Cardiomyopathies; Cardiomyopathy; Catheter ablation; Hypertrophic; Aged; Atrial Fibrillation; Cardiomyopathy, Hypertrophic; Electrophysiologic Techniques, Cardiac; Female; Humans; Male; Middle Aged; Prospective Studies; Recurrence; Retreatment; Treatment Outcome; Catheter Ablation; Cardiology and Cardiovascular Medicine; Physiology (medical)|
|Settore Scientifico Disciplinare:||Settore MED/11 - Malattie dell'Apparato Cardiovascolare|
|Data di pubblicazione:||2013|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1161/CIRCEP.113.000339|
|Appare nelle tipologie:||01 - Articolo su periodico|
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