title: Effect of transcoronary ablation of septal hypertrophy on clinical outcome in hypertrophic obstructive cardiomyopathy associated with atrial fibrillation.
abstract: BACKGROUND
  Relatively few reports on the clinical impact of atrial fibrillation (AF) in hypertrophic obstructive cardiomyopathy (HOCM) are available. The aims of our study are to report the effect of transcoronary ablation of septal hypertrophy (TASH) on clinical outcome in HOCM associated with AF and to evaluate the influence of AF on symptoms and quality of life in HOCM.
  
  
  METHODS
  In 80 consecutive patients (38 f, mean age 56 +/- 17 years) with severely symptomatic HOCM referred for interventional treatment, we analyzed the prevalence of AF based on 240 Holter ECG recordings and patients' history, retrospectively. Symptoms, quality of life, number of hospital admissions and hemodynamic performance were obtained in all patients before and after TASH. Mortality was additionally investigated by letter and telephone contact.
  
  
  RESULTS
  The overall prevalence of AF was 29%. Paroxysmal AF was detected in 17 pts (21.3%), persistent AF in 5 pts (6.3%). Only 1 pt (1.3%) suffered from permanent AF. Symptoms due to AF were present in 52.6% of the AF patients. Quality of life score was markedly improved after TASH (15.9 +/- 3.8 vs. 20.7 +/- 3.8, p < 0.001) with no difference between sinus rhythm and atrial fibrillation. However, hospital admissions were more frequent in the AF group (0.85 +/- 1.84 vs. 0.28 +/- 0.81, p = 0.03) in 32 +/- 13 months. AF patients suffered more often from syncope before TASH (30 +/- 70% vs. 10 +/- 30%, p = 0.008). Two patients with sinus rhythm at baseline died after 32 +/- 13 months from cardiovascular cause.
  
  
  CONCLUSIONS
  Atrial fibrillation is the major cardiac arrhythmia in severe HOCM. The majority of AF patients demonstrate AF specific symptoms. The paroxysmal type of atrial fibrillation dominates by far. Both patients with and without atrial fibrillation showed similar quality of life with marked improvement after TASH.
authors.affiliation: Department of Cardiology and Internal Intensive Medicine, The Bielefeld Community Hospital, Academic Teaching Hospital of the University of Muenster, Bielefeld, Germany. Ludger.Obergassel@SK-Bielefeld.de
authors.forename: L
authors.initials: L
authors.lastname: Obergassel
authors.forename: T
authors.initials: T
authors.lastname: Lawrenz
authors.forename: F H
authors.initials: FH
authors.lastname: Gietzen
authors.forename: F
authors.initials: F
authors.lastname: Lieder
authors.forename: C
authors.initials: C
authors.lastname: Leuner
authors.forename: H
authors.initials: H
authors.lastname: Kuhn
authors.forename: C
authors.initials: C
authors.lastname: Stellbrink
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000431:Ethanol