Efficacy of catheter ablation of atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy.
BACKGROUND
Although pulmonary vein (PV) antrum isolation is effective in curing atrial fibrillation (AF) in a variety of heart diseases, results in patients with hypertrophic obstructive cardiomyopathy (HOCM) have not been reported.


OBJECTIVE
The purpose of this study was to report the results and outcome of PV antrum isolation in patients with AF and HOCM.


METHODS
Data from patients with AF and HOCM who underwent PV antrum isolation between February 2002 and May 2004 were analyzed retrospectively. An intracardiac echocardiographic-guided ablation technique with an 8-mm-tip catheter was used in all patients. Patients were followed in the outpatient clinic at 3, 6, and 12 months after ablation.


RESULTS
Twenty-seven patients with AF and HOCM (mean age 55 +/- 10 years) underwent PV antrum isolation. Mean AF duration was 5.4 +/- 3.6 years. AF was paroxysmal in 14 (52%), persistent in 9 (33%), and permanent in 4 (15%). During a mean follow-up of 341 +/- 237 days, 13 patients (48%) had AF recurrence. Of these patients, five maintained sinus rhythm (SR) with antiarrhythmic drugs, one patient remained in persistent AF, and seven patients underwent a second PV antrum isolation. After the second PV antrum isolation, five patients remained in SR, giving a final success rate of 70% (19/27). Two patients had recurrence after second PV antrum isolation; one maintained SR with antiarrhythmic drugs and one remained in persistent AF.


CONCLUSIONS
Compared with previously reported results in patients with lone AF, AF recurrence after the first PV antrum isolation is higher in patients with HOCM. However, after repeated ablation procedures, long-term cure can be achieved in a sizable number of patients. PV antrum isolation is a feasible therapeutic option in patients with AF and HOCM.
Kilicaslan
Fethi
F
Section of Pacing & Electrophysiology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Verma
Atul
A
Saad
Eduardo
E
Themistoclakis
Sakis
S
Bonso
Aldo
A
Raviele
Antonio
A
Bozbas
Huseyin
H
Andrews
Michelle Williams
MW
Beheiry
Salwa
S
Hao
Steven
S
Cummings
Jennifer E
JE
Marrouche
Nassir F
NF
Lakkireddy
Dhannunjaya
D
Wazni
Oussama
O
Yamaji
Hirosuke
H
Saenz
Luis C
LC
Saliba
Walid
W
Schweikert
Robert A
RA
Natale
Andrea
A
D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011667:Pulmonary Veins / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome