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 language | English (US) |
|---|---|
| Pages (from-to) | 1438-1447 |
| Number of pages | 10 |
| Journal | Heart Rhythm |
| Volume | 12 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jul 1 2015 |
Fingerprint
Keywords
- Atrial fibrillation
- Catheter ablation
- Hypertrophic cardiomyopathy
- Maze procedure
- Pulmonary vein isolation
- Surgery
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Physiology (medical)
Cite this
Outcomes of nonpharmacologic treatment of atrial fibrillation in patients with hypertrophic cardiomyopathy. / Bassiouny, Mohamed; Lindsay, Bruce D.; Lever, Harry; Saliba, Walid; Klein, Allan; Banna, Moustafa; Abraham, Joellyn; Shao, Mingyuan; Rickard, John; Kanj, Mohamed; Tchou, Patrick; Dresing, Thomas; Baranowski, Bryan; Bhargava, Mandeep; Callahan, Thomas; Tarakji, Khaldoun; Cantillon, Daniel; Hussein, Ayman; Marc Gillinov, A.; Smedira, Nicholas G.; Wazni, Oussama.
In: Heart Rhythm, Vol. 12, No. 7, 01.07.2015, p. 1438-1447.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Outcomes of nonpharmacologic treatment of atrial fibrillation in patients with hypertrophic cardiomyopathy
AU - Bassiouny, Mohamed
AU - Lindsay, Bruce D.
AU - Lever, Harry
AU - Saliba, Walid
AU - Klein, Allan
AU - Banna, Moustafa
AU - Abraham, Joellyn
AU - Shao, Mingyuan
AU - Rickard, John
AU - Kanj, Mohamed
AU - Tchou, Patrick
AU - Dresing, Thomas
AU - Baranowski, Bryan
AU - Bhargava, Mandeep
AU - Callahan, Thomas
AU - Tarakji, Khaldoun
AU - Cantillon, Daniel
AU - Hussein, Ayman
AU - Marc Gillinov, A.
AU - Smedira, Nicholas G.
AU - Wazni, Oussama
PY - 2015/7/1
Y1 - 2015/7/1
N2 - 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.
AB - 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.
KW - Atrial fibrillation
KW - Catheter ablation
KW - Hypertrophic cardiomyopathy
KW - Maze procedure
KW - Pulmonary vein isolation
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=84937519944&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84937519944&partnerID=8YFLogxK
U2 - 10.1016/j.hrthm.2015.03.042
DO - 10.1016/j.hrthm.2015.03.042
M3 - Article
C2 - 25814420
AN - SCOPUS:84937519944
VL - 12
SP - 1438
EP - 1447
JO - Heart Rhythm
JF - Heart Rhythm
SN - 1547-5271
IS - 7
ER -