Abstract 8738: Long-term Outcomes of Catheter Ablation or Surgical Ablation to Eliminate Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy
Introduction: Atrial fibrillation (AF) is common in patients with hypertrophic cardiomyopathy (HCM). Pulmonary vein antrum isolation (PVAI) is an effective catheter-based ablation treatment for AF. Patients with obstructive HCM and AF may benefit from surgical myomectomy with concomitant surgical ablation. We analyzed outcomes of patients with HCM and AF who underwent PVAI or surgical ablation.
Methods: A total of 91 patients with HCM and medically refractory AF who underwent first time PVAI or surgical intervention — including bipolar radiofrequency ablation, cryoablation, or a full cut-and-sew MAZE between August 2000 and December 2007 were included: 48 patients underwent PVAI with an average follow-up of 18 ± 16 months, and 43 patients had a surgical ablation with an average follow-up of 36 ± 24 months which included 12-lead ECGs, Holter monitors, transtelephonic monitors, and device interrogations when available. Left-sided bipolar radiofrequency was done in 33 (77%) patients in the surgical group. Success was defined as no further episodes of documented AF greater than 30 seconds in duration off antiarrhythmic medications after a 3 month blanking period.
Results: A summary of patient outcomes is shown in the table. More than one PVAI was required in 23 (48%) patients. Patients with paroxysmal atrial fibrillation and those with smaller left atrial cavity volumes had higher incidence of success. There were no significant differences in overall AF outcomes for catheter-based and surgical ablations, but the groups were not comparable because of differences in proportions of persistent AF and obstruction.
Conclusions: Success rates for PVAI or surgical ablations are lower in patients with HCM, but both procedures offer an alternative when medical therapy is ineffective. Evolving techniques and technology are needed to improve results.
- © 2010 by American Heart Association, Inc.