title: Catheter ablation for atrial fibrillation in hypertrophic cardiomyopathy: a systematic review and meta-analysis.
abstract: Atrial fibrillation (AF) is common in hypertrophic cardiomyopathy (HCM) and is associated with a high risk of stroke. The efficacy and safety of catheter ablation in this setting is poorly characterised. We aimed to systematically review the existing literature and to perform a meta-analysis to determine the efficacy and safety of catheter ablation of AF in patients with HCM.
  
  
  
  Random-effects meta-analysis of studies comparing HCM versus non-HCM controls. The outcomes of freedom from AF/atrial tachycardia, and acute procedure-related complications were assessed. Studies were searched on MEDLINE, EMBASE, COCHRANE and clinicaltrials.gov.
  
  
  
  Fourteen studies were considered eligible for the systematic review, of which five were included in the meta-analysis. Freedom from AF/atrial tachycardia relapse was higher in patients without HCM (after a single procedure: 38.7% HCM vs 49.8% controls, OR=2.25, 95% CI 1.09 to 4.64, p=0.03; after ≥1 procedure: 51.8% HCM vs 71.2% controls, OR=2.62, 95% CI 1.52 to 4.51, p=0.0006; I(2)=33% and 26%, respectively). Risk of procedure-related adverse events was low. Repeat procedures (mean difference=0.16, 95% CI 0.0 to 0.32, p=0.05, I(2)=53%) and antiarrhythmic drugs (OR=4.70, 95% CI 2.31 to 9.55, p<0.0001, I(2)=0%) are more frequently needed in patients with HCM to prevent arrhythmia relapse. Sensitivity analyses suggested that the outcome in patients with HCM with less dilated atria and paroxysmal AF may be more comparable to the general population.
  
  
  
  The observed complication rate of catheter ablation of AF in patients with HCM was low. Even though the risk of relapse is twofold higher, catheter ablation can be effective in patients with HCM and AF, particularly in patients with paroxysmal AF and smaller atria.
authors.affiliation: Barts Heart Centre, Barts Health NHS Trust, London, UK.
authors.forename: Rui
authors.initials: R
authors.lastname: Providencia
authors.affiliation: Barts Heart Centre, Barts Health NHS Trust, London, UK Institute of Cardiovascular Science, University College of London, London, United Kingdom.
authors.forename: Perry
authors.identifier: 0000-0003-3383-3984
authors.initials: P
authors.lastname: Elliott
authors.affiliation: Institute of Cardiovascular Science, University College of London, London, United Kingdom.
authors.forename: Kiran
authors.initials: K
authors.lastname: Patel
authors.affiliation: Cardiology Department, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
authors.forename: Jack
authors.initials: J
authors.lastname: McCready
authors.affiliation: Barts Heart Centre, Barts Health NHS Trust, London, UK.
authors.forename: Girish
authors.initials: G
authors.lastname: Babu
authors.affiliation: Barts Heart Centre, Barts Health NHS Trust, London, UK Institute of Cardiovascular Science, University College of London, London, United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: Srinivasan
authors.affiliation: Barts Heart Centre, Barts Health NHS Trust, London, UK.
authors.forename: Kostantinos
authors.initials: K
authors.lastname: Bronis
authors.affiliation: Barts Heart Centre, Barts Health NHS Trust, London, UK Institute of Cardiovascular Science, University College of London, London, United Kingdom.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Papageorgiou
authors.affiliation: Barts Heart Centre, Barts Health NHS Trust, London, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Chow
authors.affiliation: Barts Heart Centre, Barts Health NHS Trust, London, UK.
authors.forename: Edward
authors.initials: E
authors.lastname: Rowland
authors.affiliation: Barts Heart Centre, Barts Health NHS Trust, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Lowe
authors.affiliation: Barts Heart Centre, Barts Health NHS Trust, London, UK.
authors.forename: Oliver R
authors.initials: OR
authors.lastname: Segal
authors.affiliation: Barts Heart Centre, Barts Health NHS Trust, London, UK Institute of Cardiovascular Science, University College of London, London, United Kingdom.
authors.forename: Pier D
authors.initials: PD
authors.lastname: Lambiase
mesh_terms: D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications*; D017115:Catheter Ablation / Q000009:adverse effects; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents