Outcomes of nonpharmacologic treatment of atrial fibrillation in patients with hypertrophic cardiomyopathy

Mohamed Bassiouny, Bruce D. Lindsay, Harry Lever, Walid Saliba, Allan Klein, Moustafa Banna, Joellyn Abraham, Mingyuan Shao, John Rickard, Mohamed Kanj, Patrick Tchou, Thomas Dresing, Bryan Baranowski, Mandeep Bhargava, Thomas Callahan, Khaldoun Tarakji, Daniel Cantillon, Ayman Hussein, A. Marc Gillinov, Nicholas G. SmediraOussama Wazni

Research output: Contribution to journalArticle

Abstract

Background Limited data exist regarding the outcome of atrial fibrillation (AF) surgery and catheter ablation in patients with hypertrophic cardiomyopathy (HCM). Objective The purpose of this study was to evaluate the safety and efficacy of nonpharmacologic treatment of AF in HCM. Methods One hundred forty-seven patients (46 female, age 55 ± 11 years, ejection fraction [EF] 58% ± 8%) with symptomatic paroxysmal (58%), persistent (31%), and long-standing persistent AF (11%) refractory to antiarrhythmic drugs who presented for their first catheter ablation (n = 79) or AF surgery (n = 68) were included. Results After follow-up of 35 months (interquartile range 13, 60), 29% of patients who underwent catheter ablation and 51% of those who had undergone AF surgery had no documented recurrent atrial arrhythmia after a single procedure. Repeat ablation was performed in 55% of patients with recurrent arrhythmia in the catheter group and 24% in the surgery group, increasing the success rate to 39% and 53%, respectively, after 1 or more procedures. Predictors of success after the first procedure in a multivariable setting included higher baseline EF and male gender. Persistent or long-standing AF and log of AF duration were associated with lower success. Major complications occurred in 6% of the catheter ablation group and 18% of the AF surgery group. During follow-up, 16 patients died (9 in catheter group, 7 in surgery group) and 1 underwent heart replacement. Lower baseline EF and older age were independently associated with death. Conclusion Catheter ablation and AF surgery are associated with symptomatic improvement in HCM patients. However, long-term success is lower and complications are higher than previously reported.

Original languageEnglish (US)
Pages (from-to)1438-1447
Number of pages10
JournalHeart Rhythm
Volume12
Issue number7
DOIs
StatePublished - Jul 1 2015

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Hypertrophic cardiomyopathy
  • Maze procedure
  • Pulmonary vein isolation
  • Surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Bassiouny, M., Lindsay, B. D., Lever, H., Saliba, W., Klein, A., Banna, M., Abraham, J., Shao, M., Rickard, J., Kanj, M., Tchou, P., Dresing, T., Baranowski, B., Bhargava, M., Callahan, T., Tarakji, K., Cantillon, D., Hussein, A., Marc Gillinov, A., ... Wazni, O. (2015). Outcomes of nonpharmacologic treatment of atrial fibrillation in patients with hypertrophic cardiomyopathy. Heart Rhythm, 12(7), 1438-1447. https://doi.org/10.1016/j.hrthm.2015.03.042