Complete pulmonary vein isolation guided by three-dimensional electroanatomical mapping for the treatment of paroxysmal atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy.
OBJECTIVE
Evaluation of the clinical outcome of patients with hypertrophic obstructive cardiomyopathy (HOCM) and paroxysmal atrial fibrillation (AF) treated with complete pulmonary vein (PV) isolation guided by three-dimensional (3-D) electroanatomical (EA) mapping.


METHODS
Circumferential radiofrequency (RF) ablation and continuous circular lesions (CCLs) around the left and right-sided PVs were performed in 4 highly symptomatic patients (2 males; age 57.5 +/- 8.3 years) with HOCM and anti-arrhythmic drug (AAD) refractory paroxysmal AF. Ablation was guided by 3-D EA mapping combined with conventional circumferential PV mapping. The endpoints of the ablation were defined as: (1) absence of all PV spikes documented with the two Lasso catheters within the ipsilateral PVs; and (2) no recurrence of the PV spikes within all PVs following intravenous administration of adenosine.


RESULTS
The ablation endpoints were achieved in all patients. A repeat ablation was performed in one patient due to repetitive atrial tachycardia, 1 month after the initial procedure. During a follow-up of 5.8 +/- 2.7 months, all patients are free of AF recurrence. Short episodes of symptomatic AT were documented after the repeat procedure, and were well controlled with oral amiodarone in the patient. No procedure-related complications were observed.


CONCLUSIONS
The present study demonstrates that complete isolation of ipsilateral PVs guided by 3-D EA mapping is potentially effective for the treatment of highly symptomatic, drug refractory paroxysmal AF in patients with HOCM.
Liu
Xingpeng
X
II. Med. Abteilung, Allgemeines Krankenhaus St. Georg, Hamburg, Germany.
Ouyang
Feifan
F
Mavrakis
Hercules
H
Ma
Changsheng
C
Dong
Jianzeng
J
Ernst
Sabine
S
Bänsch
Dietmar
D
Antz
Matthias
M
Kuck
Karl-Heinz
KH
D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications* / Q000503:physiopathology; D017115:Catheter Ablation; D017023:Coronary Angiography; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology*; D015641:Radiography, Interventional; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome