Catheter ablation for atrial fibrillation in hypertrophic cardiomyopathy: a systematic review and meta-analysis

National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018

“…Multiple small studies have shown catheter ablation for AF to be a reasonable and safe option to maintain sinus rhythm and improve symptoms in HCM patients [210]. A systematic review of 14 observational studies reported freedom from atrial arrhythmia following catheter ablation in 51.8% of patients, with a median follow-up of 1.8 years after a median of 1.4 procedures [211] (see Section 5.3.3).…”

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary

“…Indications for catheter ablation of atrial fibrillation  Symptomatic AF refractory or intolerant to at least one Class I or III antiarrhythmic medicationParoxysmal: Catheter ablation is recommended.IA[7–18]Persistent: Catheter ablation is reasonable.IIaB-NR[8, 16–26]Long-standing persistent: Catheter ablation may be considered.IIbC-LD[8, 16–26]  Symptomatic AF prior to initiation of antiarrhythmic therapy with a Class I or III antiarrhythmic medicationParoxysmal: Catheter ablation is reasonable.IIaB-R[27–35]Persistent: Catheter ablation is reasonable.IIaC-EOLong-standing persistent: Catheter ablation may be considered.IIbC-EO B. Indications for catheter atrial fibrillation ablation in populations of patients not well represented in clinical trials  Congestive heart failureIt is reasonable to use similar indications for AF ablation in selected patients with heart failure as in patients without heart failure.IIaB-R[36–52]  Older patients (>75 years of age)It is reasonable to use similar indications for AF ablation in selected older patients with AF as in younger patients.IIaB-NR[53–59]  Hypertrophic cardiomyopathyIt is reasonable to use similar indications for AF ablation in selected patients with HCM as in patients without HCM.IIaB-NR[60–62]  Young patients (<45 years of age)It is reasonable to use similar indications for AF ablation in young patients with AF (<45 years of age) as in older patients.IIaB-NR[63, 64]  Tachy-brady syndromeIt is reasonable to offer AF ablation as an alternative to pacemaker implantation in patients with tachy-brady syndrome.IIaB-NR[33–35]  Athletes with AFIt is reasonable to offer high-level athletes AF as first-line therapy due to the negative effects of medications on athletic performance.IIaC-LD[27, 28, …”

Enlarged left atrium, atrial fibrillation and adverse outcome in hypertrophic cardiomyopathy: is there a difference between apical and non-apical phenotype?

“…Thus, the use of catheter ablation for AF is an attractive strategy, although evidence for the efficacy of AF ablation in this population is also limited. A recent meta-analysis showed that outcomes were less favourable for patients with HCM than for the general population, with a twofold higher risk of relapse, more frequent need of repeat procedures and concomitant use of antiarrhythmic drugs 9. Nevertheless, the meta-analysis also suggested that ablation is a valuable option for symptomatic drug-refractory patients with HCM with paroxysmal AF and a smaller left atria, with a low observed complication rate 9.…”

“…A recent meta-analysis showed that outcomes were less favourable for patients with HCM than for the general population, with a twofold higher risk of relapse, more frequent need of repeat procedures and concomitant use of antiarrhythmic drugs 9. Nevertheless, the meta-analysis also suggested that ablation is a valuable option for symptomatic drug-refractory patients with HCM with paroxysmal AF and a smaller left atria, with a low observed complication rate 9. In addition, a recent single-centre retrospective study showed that AF ablation was similarly effective in patients with apical HCM compared with non-apical HCM 10.…”