title: Outcomes of nonpharmacologic treatment of atrial fibrillation in patients with hypertrophic cardiomyopathy.
abstract: BACKGROUND
  Limited data exist regarding the outcome of atrial fibrillation (AF) surgery and catheter ablation in patients with hypertrophic cardiomyopathy (HCM).
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the safety and efficacy of nonpharmacologic treatment of AF in HCM.
  
  
  METHODS
  One hundred forty-seven patients (46 female, age 55 ± 11 years, ejection fraction [EF] 58% ± 8%) with symptomatic paroxysmal (58%), persistent (31%), and long-standing persistent AF (11%) refractory to antiarrhythmic drugs who presented for their first catheter ablation (n = 79) or AF surgery (n = 68) were included.
  
  
  RESULTS
  After follow-up of 35 months (interquartile range 13, 60), 29% of patients who underwent catheter ablation and 51% of those who had undergone AF surgery had no documented recurrent atrial arrhythmia after a single procedure. Repeat ablation was performed in 55% of patients with recurrent arrhythmia in the catheter group and 24% in the surgery group, increasing the success rate to 39% and 53%, respectively, after 1 or more procedures. Predictors of success after the first procedure in a multivariable setting included higher baseline EF and male gender. Persistent or long-standing AF and log of AF duration were associated with lower success. Major complications occurred in 6% of the catheter ablation group and 18% of the AF surgery group. During follow-up, 16 patients died (9 in catheter group, 7 in surgery group) and 1 underwent heart replacement. Lower baseline EF and older age were independently associated with death.
  
  
  CONCLUSIONS
  Catheter ablation and AF surgery are associated with symptomatic improvement in HCM patients. However, long-term success is lower and complications are higher than previously reported.
authors: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors: Mohamed
authors: M
authors: Bassiouny
authors: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors: Bruce D
authors: BD
authors: Lindsay
authors: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors: Harry
authors: H
authors: Lever
authors: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors: Walid
authors: W
authors: Saliba
authors: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors: Allan
authors: A
authors: Klein
authors: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors: Moustafa
authors: M
authors: Banna
authors: Minneapolis Heart Institute, Minneapolis, Minnesota.
authors: JoEllyn
authors: J
authors: Abraham
authors: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors: Mingyuan
authors: M
authors: Shao
authors: Johns Hopkins, Baltimore, Maryland.
authors: John
authors: J
authors: Rickard
authors: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors: Mohamed
authors: M
authors: Kanj
authors: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors: Patrick
authors: P
authors: Tchou
authors: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors: Thomas
authors: T
authors: Dresing
authors: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors: Bryan
authors: B
authors: Baranowski
authors: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors: Mandeep
authors: M
authors: Bhargava
authors: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors: Thomas
authors: T
authors: Callahan
authors: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors: Khaldoun
authors: K
authors: Tarakji
authors: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors: Daniel
authors: D
authors: Cantillon
authors: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors: Ayman
authors: A
authors: Hussein
authors: Department of Cardiothoracic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors: A
authors: A
authors: Marc Gillinov
authors: Department of Cardiothoracic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors: Nicholas G
authors: NG
authors: Smedira
authors: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. Electronic address: waznio@ccf.org.
authors: Oussama
authors: O
authors: Wazni
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D011379:Prognosis; D011667:Pulmonary Veins / Q000601:surgery; D012008:Recurrence; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D013318:Stroke Volume; D014481:United States
keywords: Atrial fibrillation; Catheter ablation; Hypertrophic cardiomyopathy; Maze procedure; Pulmonary vein isolation; Surgery