Efficacy of catheter ablation for atrial fibrillation in hypertrophic cardiomyopathy: impact of age, atrial remodelling, and disease progression

被引:102
作者
Di Donna, Paolo [1 ,2 ]
Olivotto, Iacopo [3 ]
Delcre, Sara Dalila Luisella [1 ,2 ]
Caponi, Domenico [1 ,2 ]
Scaglione, Marco [1 ,2 ]
Nault, Isabelle [4 ,5 ]
Montefusco, Antonio [1 ,2 ]
Girolami, Francesca [3 ]
Cecchi, Franco [3 ]
Haissaguerre, Michel [4 ,5 ]
Gaita, Fiorenzo [1 ,2 ]
机构
[1] Univ Turin, Div Cardiol, Cardinal Massaia Hosp Asti, I-14100 Asti, Italy
[2] Univ Turin, Fac Med, I-14100 Asti, Italy
[3] Careggi Univ Hosp, Referral Ctr Myocardial Dis, Florence, Italy
[4] Hop Cardiol Haut Leveque, Bordeaux, France
[5] Univ Victor Segalen, Bordeaux, France
来源
EUROPACE | 2010年 / 12卷 / 03期
关键词
Hypertrophic cardiomyopathy; Atrial fibrillation; Radiofrequency ablation; Outcome; Genetics; SUBAORTIC STENOSIS; CLINICAL-COURSE; COHORT;
D O I
10.1093/europace/euq013
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 <= 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.
引用
收藏
页码:347 / 355
页数:9
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