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Efficacy of catheter ablation for atrial fibrillation in hypertrophic cardiomyopathy: impact of age, atrial remodelling, and disease progression
Open accessAbstract
AIMS: In patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF), radiofrequency catheter ablation (RFCA) represents a promising option. However, the predictors of RFCA efficacy remain largely unknown. We assessed the outcome of a multicentre HCM cohort following RFCA for symptomatic AF refractory to medical therapy. METHODS AND RESULTS: Sixty-one patients (age 54 +/- 13 years; time from AF onset 5.7 +/- 5.5 years) with paroxysmal (n = 35; 57%), recent persistent (n = 15; 25%), or long-standing persistent AF (n = 11; 18%) were enrolled. A scheme with pulmonary vein isolation plus linear lesions was employed. Of the 61 patients, 32 (52%) required redo procedures. Antiarrhythmic therapy was maintained in 22 (54%). At the end of a 29 +/- 16 months follow-up, 41 patients (67%) were in sinus rhythm, including 17 of the 19 patients aged < or = 50 years, with marked improvement in New York Heart Association (NYHA) functional class (1.2 +/- 0.5 vs. 1.9 +/- 0.7 at baseline; P < 0.001). In the remaining 20 patients (33%), with AF recurrence, there was less marked, but still significant, improvement following RFCA (NYHA class 1.8 +/- 0.7 vs. 2.3 +/- 0.7 at baseline; P = 0.002). Independent predictors of AF recurrence were increased left atrium volume [hazard ratio (HR) per unit increase 1.009, 95% confidence interval (CI) 1.001-1.018; P = 0.037] and NYHA functional class (HR 2.24, 95% CI 1.16-4.35; P = 0.016). Among 11 genotyped HCM patients (6 with MYBPC3, 2 with MYH7, 1 with MYL2 and 2 with multiple mutations), RFCA success rate was comparable with that of the overall cohort (n = 8; 73%). CONCLUSION: RFCA was successful in restoring long-term sinus rhythm and improving symptomatic status in most HCM patients with refractory AF, including the subset with proven sarcomere gene mutations, although redo procedures were often necessary. Younger HCM patients with small atrial size and mild symptoms proved to be the best RFCA candidates, likely due to lesser degrees of atrial remodelling.
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“AF ablation is effective to suppress symptomatic AF recurrences.[880][881][882][883][884]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [881]
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“Previous studies have demonstrated that RFCA for severely symptomatic AF is both a feasible and safe approach in patients with HCM, 15 and may provide similar benefits to those obtained in secondary structural heart disease.(13) However, due to the peculiar nature of the HCM disease process, the efficacy of RFCA in ma…”
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2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy
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Self-citation2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation
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Metadata
- Authors
- Di Donna, P., Olivotto, I., Delcre, S. D. L., Caponi, D., Scaglione, M., Nault, I., Montefusco, A., Girolami, F., Cecchi, F., Haissaguerre, M., & Gaita, F.
- Affiliations
- Azienda Ospedaliero-Universitaria Careggi (IT)
- University of Turin (IT)
- Hôpital Cardiologique du Haut-Lévêque (FR)
- Venue
- Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-02-20
- Volume
- 12
- Issue
- 3
- Pages
- 347-355
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- OpenAlex
- W2171261466
- Cited by
- 138
- References
- 28
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 5 · 2023: 5 · 2022: 4 · 2021: 8 · 2020: 10 · 2019: 8 · 2018: 11 · 2017: 8 · 2016: 14 · 2015: 8 · 2014: 18 · 2013: 10 · 2012: 12
- FWCI
- 7.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- EP Europace (publishedVersion)
- PubMed (publishedVersion)
- Florence Research (University of Florence) (submittedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- Funders
- European Commission (241577)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- hypertrophic cardiomyopathy, atrial fibrillation, radiofrequency catheter ablation, pulmonary vein isolation, atrial remodeling, left atrial volume, NYHA functional class, age, disease progression, arrhythmia recurrence, repeat ablation, genotypes, MYBPC3, MYH7, myosin light chain 2, antiarrhythmic therapy, predictors of treatment outcome, sinus rhythm
- MeSH terms
- Adult, Age Factors, Aged, Anti-Arrhythmia Agents, Atrial Fibrillation, Cardiomyopathy, Hypertrophic, Combined Modality Therapy, Female, Follow-Up Studies, Genetic Testing, Genotype, Heart Atria, Humans, Male, Middle Aged, Predictive Value of Tests, Echocardiography, Doppler, Treatment Outcome, Catheter Ablation, Disease Progression
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