Catheter ablation for atrial fibrillation in hypertrophic cardiomyopathy patients: a systematic review

Abstract

A review of the current evidence suggests that catheter ablation of AF in HCM patients is effective with suitable efficacy and is justified in select patients. Future adequately powered randomized studies should be undertaken aimed at addressing long-term efficacy and complications associated with procedural outcomes.

Outcomes in hypertrophic cardiomyopathy patients with and without atrial fibrillation: a survival meta-analysis

“…It remains poorly understood why HCM patients with AF undergoing ablation (either catheter based or surgical) have higher rates of recurrence as compared to AF in non-HCM patients (23)(24)(25)(26)(27). A recent met-analysis have shown how it is feasible to perform catheter ablation for HCM patients with AF, but with a 32.9% single procedure success without anti-arrhythmics, that rose to 50.4% with multiple procedures (28). Currently, there is not enough data evaluating incidence of cardiovascular events or mortality in patients with HCM and AF undergoing invasive interventions to eliminate AF as compared to those receiving medications only (for either rhythm or rate control).…”

State-of-the-Art Treatments for Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy

“…The authors concluded that most patients require re-do procedures, that efficacy was obtained with the concomitant administration of AADs in most patients and that efficacy was time dependent. Three meta-analyses [ 23 , 24 , 25 ] on AF and HCM have been published in the last 5 years. Table 1 shows a summary of these three studies.…”

Catheter ablation of atrial tachycardias after mitral valve surgery

“…Finally, an important distinction that was made was that patients with paroxysmal AF had AF/AT‐free survival that was greater than patients with nonparoxysmal AF. Like patients with HCM, 73% of patients with mitral valve prostheses were reported to have AF‐free survival after 1 year of follow‐up with only 5% of patients with HCM experiencing major complications 12,13 . Furthermore, patients with a prior insertion of a mitral valve prosthesis are more likely to require a repeat ablation for AT 14 .…”

“…However, if AT/AF is already present, it is ideal to do catheter ablation during cardiac surgery. Furthermore, Ha et al 12 and Zhao et al 13 assessed the impact of catheter ablation on patients with hypertrophic cardiomyopathy (HCM), they reported that median AF‐free survival was 65% with 43% of patients requiring reoperation after a median follow‐up of 18 months. In addition, reoperation improved AF‐free survival.…”

“…Like patients with HCM, 73% of patients with mitral valve prostheses were reported to have AF-free survival after 1 year of follow-up with only 5% of patients with HCM experiencing major complications. 12,13 Furthermore, patients with a prior insertion of a mitral valve prosthesis are more likely to require a repeat ablation for AT. 14 However, Zhan et al 9 reported that after a mean follow-up of 46.9 ± 15.7 months of patients with MVS who did catheter ablation of AT, 74% of these patients remained in SR after a single procedure as compared to 82% of patients who did repeated procedures.…”