title: Catheter ablation of atrial fibrillation in hypertrophic cardiomyopathy: long-term outcomes and mechanisms of arrhythmia recurrence.
abstract: BACKGROUND
  Pulmonary vein (PV) antrum isolation in patients with hypertrophic cardiomyopathy and atrial fibrillation (AF) has been reported to have satisfactory results at the mid- and short-term follow-up. We determined the outcomes at the long-term follow-up of PV antrum isolation in these patients.
  
  
  RESULTS
  We enrolled 43 patients with hypertrophic cardiomyopathy and AF (28% paroxysmal AF). PV antrum isolation (paroxysmal AF) and posterior wall isolation with complex fractionated atrial electrogram ablation (persistent and longstanding persistent AF) were the end points at the time of the index procedure and for repeat procedures during the first year of follow-up. In case of recurrent arrhythmia >1 year, high-dose isoproterenol challenge was used to disclose non-PV trigger sites. During the first year, the success rate reached 91% (mean of 1.6 procedures). After a median follow-up of 42 months (range, 38-48 months), 49% of the patients remained free from AF/atrial tachycardia. All patients underwent an additional procedure. PV antrum and posterior wall remained isolated in 82% of the cases, and extra-PV triggers were documented in all patients and targeted for ablation. After a median follow-up of 15 months (range, 8-19 months) subsequent to the last procedure, 94% of the patients remained free from AF/atrial tachycardia off antiarrhythmic drugs.
  
  
  CONCLUSIONS
  PV isolation in patients with hypertrophic cardiomyopathy is feasible and safe, although is not effective in preventing late (≥1 year) AF recurrences in ≈50% of patients. Non-PV triggers seem to be responsible of late recurrences, which supports the appropriateness of a more extensive ablation beyond PV isolation to improve the long-term arrhythmia-free survival.
authors.affiliation: Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.forename: Sakis
authors.initials: S
authors.lastname: Themistoclakis
authors.forename: Antonio
authors.initials: A
authors.lastname: Raviele
authors.forename: Robert A
authors.initials: RA
authors.lastname: Schweikert
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
authors.forename: Prasant
authors.initials: P
authors.lastname: Mohanty
authors.forename: Rong
authors.initials: R
authors.lastname: Bai
authors.forename: Sanghamitra
authors.initials: S
authors.lastname: Mohanty
authors.forename: Agnes
authors.initials: A
authors.lastname: Pump
authors.forename: Salwa
authors.initials: S
authors.lastname: Beheiry
authors.forename: Richard
authors.initials: R
authors.lastname: Hongo
authors.forename: Javier E
authors.initials: JE
authors.lastname: Sanchez
authors.forename: G Joseph
authors.initials: GJ
authors.lastname: Gallinghouse
authors.forename: Rodney
authors.initials: R
authors.lastname: Horton
authors.forename: Antonio
authors.initials: A
authors.lastname: Dello Russo
authors.forename: Michela
authors.initials: M
authors.lastname: Casella
authors.forename: Gaetano
authors.initials: G
authors.lastname: Fassini
authors.forename: Claude S
authors.initials: CS
authors.lastname: Elayi
authors.forename: J David
authors.initials: JD
authors.lastname: Burkhardt
authors.forename: Claudio
authors.initials: C
authors.lastname: Tondo
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications; D017115:Catheter Ablation / Q000379:methods; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D019233:Retreatment; D016896:Treatment Outcome
keywords: atrial fibrillation; cardiomyopathies; cardiomyopathy, hypertrophic; catheter ablation