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Ezzeddine FM, Agboola KM, Hassett LC, Killu AM, Del-Carpio Munoz F, DeSimone CV, Kowlgi GN, Deshmukh AJ, Siontis KC. Catheter ablation of atrial fibrillation in patients with and without hypertrophic cardiomyopathy: systematic review and meta-analysis. Europace 2023; 25:euad256. [PMID: 37595138 PMCID: PMC10498139 DOI: 10.1093/europace/euad256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/14/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is common in hypertrophic cardiomyopathy (HCM). There is limited data regarding the outcomes of AF catheter ablation in HCM patients. In this study, we aimed to synthesize all available evidence on the effectiveness of ablation of AF in patients with HCM compared to those without HCM. METHODS AND RESULTS We systematically reviewed bibliographic databases to identify studies published through February 2023. We included cohort studies with available quantitative information on rates of recurrent atrial arrhythmias, anti-arrhythmic drug (AAD) therapy, and repeat ablation procedures after initial AF ablation in patients with vs without HCM. Estimates were combined using random-effects meta-analysis models and reported as risk ratios (RR) and 95% confidence intervals (CI). Eight studies were included in quantitative synthesis (262 HCM and 642 non-HCM patients). During median follow-up 13-54 months across studies, AF recurrence rates ranged from 13.3% to 92.9% in HCM and 7.6% to 58.8% in non-HCM patients. The pooled RR for recurrent atrial arrhythmia after the first AF ablation in HCM patients compared to non-HCM controls was 1.498 (95% CI = 1.305-1.720; P < 0.001). During follow-up, HCM patients more often required AAD therapy (RR = 2.844; 95% CI = 1.713-4.856; P < 0.001) and repeat AF ablation (RR = 1.544; 95% CI = 1.070-2.228; P = 0.02). The pooled RR for recurrent atrial arrhythmias after the last AF ablation was higher in patients with HCM than those without HCM (RR = 1.607; 95% CI = 1.235-2.090; P < 0.001). CONCLUSIONS Compared to non-HCM patients, those with HCM had higher rates of recurrent atrial arrhythmias, AAD use, and need for repeat AF ablation after initial ablation of AF.
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Affiliation(s)
- Fatima M Ezzeddine
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 59905, USA
| | - Kolade M Agboola
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 59905, USA
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 59905, USA
| | - Freddy Del-Carpio Munoz
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 59905, USA
| | - Christopher V DeSimone
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 59905, USA
| | - Gurukripa N Kowlgi
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 59905, USA
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 59905, USA
| | - Konstantinos C Siontis
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 59905, USA
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Latif A, Ahmad S, Ahsan MJ, Willman C, Lateef N, Kapoor V, Ikram S, Ahsan MZ, Meyers J, Kim MH. Catheter ablation of atrial fibrillation in hypertrophic cardiomyopathy: A proportional meta-analysis and systematic review of single-arm studies. Heart Rhythm O2 2023; 4:258-267. [PMID: 37124551 PMCID: PMC10134396 DOI: 10.1016/j.hroo.2023.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background Atrial fibrillation (AF) is the most common arrhythmia in patients with hypertrophic cardiomyopathy (HCM). Limited data exists about the efficacy and clinical outcomes of AF ablation in HCM. Objective The purpose of this meta-analysis was to evaluate the role of catheter-based ablation for treatment of AF in patients with HCM. Methods PubMed, SCOPUS, Web of Science, Embase, Cochrane library, and ClinicalTrials.gov were searched for studies discussing outcomes of catheter-based ablation for AF in patients with HCM. Two reviewers independently screened studies and extracted relevant data. Incidence rate estimates from individual studies underwent logit transformation to calculate the weighted summary proportion under the random effect model. Results A total of 19 reports met the inclusion criteria (1183 patients). The single ablation procedure was successful in 39% patients. Up to 34% patients underwent a repeat ablation. About 41% patients in normal sinus rhythm after successful AF ablation received postprocedure antiarrhythmic drug (AAD) therapy. Patients undergoing successful AF ablation experienced a significant improvement in the New York Heart Association functional class (standardized mean difference -1.03; 95% confidence interval -1.23 to -0.83; P < .00001). Conclusion AF ablation appears to be safe and feasible in patients with HCM. Freedom from AF after undergoing successful ablation is associated with significant improvement in heart failure symptoms.
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Affiliation(s)
- Azka Latif
- Department of Cardiovascular Disease, Baylor University, Houston, Texas
| | - Soban Ahmad
- Department of Internal Medicine, East Carolina University, Greenville, North Carolina
| | | | - Claire Willman
- Department of Cardiovascular Disease, Creighton University, Omaha, Nebraska
| | - Noman Lateef
- Department of Cardiovascular Disease, University of Nebraska Medical Center, Omaha, Nebraska
| | - Vikas Kapoor
- Department of Cardiovascular Disease, Creighton University, Omaha, Nebraska
| | - Sundus Ikram
- Department of Internal Medicine, SEGi University, Petaling Jaya, Malaysia
| | | | - Jason Meyers
- Department of Cardiovascular Disease, MercyOne Medical Center, Des Moines, Iowa
| | - Michael H. Kim
- Department of Cardiovascular Disease, Creighton University, Omaha, Nebraska
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Faraz F, Rehman MEU, Sabir B, Ghaffar A, Iftikhar A, Maqsood A, Ahmad Cheema H, Yasmin F, Aamir M, Ahmed MU, Asghar MS. Efficacy of Catheter Ablation for Atrial Fibrillation in Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2023; 48:101524. [PMID: 36455792 DOI: 10.1016/j.cpcardiol.2022.101524] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in patients with hypertrophic cardiomyopathy (HCM). Catheter ablation (CA) has emerged as an effective therapy for AF. We conducted a meta-analysis to update the current clinical evidence on the efficacy of CA for AF in patients with HCM. We searched PubMed, Embase, Cochrane and Clinicaltrials.gov for interventional and observational studies assessing single and multiple procedure success rate of CA in HCM patients. Our meta-analysis included 25 studies involving 1817 patients. Success rate following single procedure was 40.4% (95% CI 33.1 to 48.0%) at latest follow-up. The pooled success rate following multiple procedures was 51.4% (95% CI 42.9% to 60.0%) at latest follow-up. In the subgroup analysis for AF subtype, TCA was more successful for paroxysmal AF compared to non-paroxysmal AF. For the subset of studies reporting drug-free success rate, single and multiple procedures had a success rate of 33.4% (95% CI 19.3 to 49.1%) and 51.8% (95% CI 41.3 to 62.2%) at latest follow-up, respectively. CA is a suitable option for AF in patients with HCM. Success rate is greater in paroxysmal AF, after multiple procedures and with antiarrhythmic drugs.
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Affiliation(s)
- Fatima Faraz
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | | | - Beenish Sabir
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Areeba Ghaffar
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Ahmad Iftikhar
- Department of Medicine, The University of Arizona, Tucson, AZ
| | - Aimen Maqsood
- Department of Medicine, Mohtarma Benazir Bhutto Shaheed Medical College, Mirpur, Azad and Jammu Kashmir
| | | | - Farah Yasmin
- Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Aamir
- Lehigh Valley Heart Specialists, Lehigh Valley Health Network, Allentown, PA
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Characteristics of left atrial remodeling in patients with atrial fibrillation and hypertrophic cardiomyopathy in comparison to patients without hypertrophy. Sci Rep 2021; 11:12411. [PMID: 34127728 PMCID: PMC8203718 DOI: 10.1038/s41598-021-91892-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/01/2021] [Indexed: 01/15/2023] Open
Abstract
Atrial fibrillation (AF) leads to remodeling characterized by changes in both size and shape of the left atrium (LA). Here we aimed to study the effect of hypertrophic cardiomyopathy (HCM) on the pattern of LA remodeling in AF-patients. HCM-patients (n = 23) undergoing AF ablation (2009–2012) were matched and compared with 125 Non-HCM patients from our prospective registry. Pre-procedural CT data were analyzed (EnSite Verismo, SJM, MN) to determine the maximal sagittal (anterior–posterior, AP), coronal (superior-inferior, SI and transversal, TV) dimensions and the sphericity index (LAS). Volume (LAV) was rendered after appendage (LAA) and pulmonary vein (PV) exclusion. A cutting plane, between PV ostia/LAA and parallel to the posterior wall, divided LAV into anterior- (LAA) and posterior-LA (LAP) parts. The ratio LA-A/LAV was defined as asymmetry index (ASI). HCM patients had a wider inter-ventricular septum and a smaller LV than Non-HCM patients. LA volume (LAV 166 ± 72 vs. 130 ± 36 ml, p = 0.03) and LA diameters were significantly larger in HCM patients. Anterior volume (LA-A: 112 ± 48 vs. 83 ± 26 ml, p < 0.001) differed significantly between groups, whereas the posterior volume LA-P (55 ± 28 vs. 47 ± 13 ml, p = 0.23) and LAS (75% vs. 78%, p = 0.089) was similar in both groups. As a result, ASI was significantly higher (67 ± 6 vs. 63 ± 6%, p = 0.01) in HCM than in Non-HCM patients. In conclusion, LA remodeling in patients with AF and HCM is characterized by asymmetric dilatation, driven by an anterior rather than a posterior dilatation. This can be characterized by three-dimensional imaging and could be used as surrogate of advanced atrial remodeling.
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Atrial Fibrillation in Hypertrophic Cardiomyopathy: Evidence-based Review About Mechanism, Complications and Management. Crit Pathw Cardiol 2020; 19:87-89. [PMID: 32011359 DOI: 10.1097/hpc.0000000000000210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is 1 of the most frequent genetic cardiovascular diseases affecting 1 out of every 500 individuals in general population. Atrial Fibrillation incidences were 3.8% per 100 patients per year and overall prevalence among HCM patients are 27.09%. Higher risk of death noted in HCM patients with atrial fibrillation. Stroke and other thrombo embolic risks are increased in such patients. Medical management using mainly betablockers or amiodarone produced variable results and high rate of recurrence. Catheter ablation reduced symptom burden and complications despite moderate recurrence. Patients with multiple repeated procedures found to have better success rate and outcomes. The complications are not high leading to increased feasibility of the procedure. More research using latest techniques in catheter ablation need to be studied.
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Zheng S, Jiang W, Dai J, Li K, Shi H, Wu W, Liu X, He B, Qiu X, Song Z. Five‐year outcomes after catheter ablation for atrial fibrillation in patients with hypertrophic cardiomyopathy. J Cardiovasc Electrophysiol 2020; 31:621-628. [DOI: 10.1111/jce.14349] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/09/2019] [Accepted: 01/07/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Shunwen Zheng
- Shanghai Chest HospitalShanghai Jiao Tong University Shanghai China
| | - Weifeng Jiang
- Shanghai Chest HospitalShanghai Jiao Tong University Shanghai China
| | - Jinjie Dai
- Shanghai Chest HospitalShanghai Jiao Tong University Shanghai China
| | - Kaige Li
- Shanghai Chest HospitalShanghai Jiao Tong University Shanghai China
| | - Hongyu Shi
- Shanghai Chest HospitalShanghai Jiao Tong University Shanghai China
| | - Weihua Wu
- Shanghai Chest HospitalShanghai Jiao Tong University Shanghai China
| | - Xu Liu
- Shanghai Chest HospitalShanghai Jiao Tong University Shanghai China
| | - Ben He
- Shanghai Chest HospitalShanghai Jiao Tong University Shanghai China
| | - Xingbiao Qiu
- Shanghai Chest HospitalShanghai Jiao Tong University Shanghai China
| | - Zhiping Song
- Central Hospital of Minhang DistrictFudan University Shanghai China
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Providencia R, Elliott P, Patel K, McCready J, Babu G, Srinivasan N, Bronis K, Papageorgiou N, Chow A, Rowland E, Lowe M, Segal OR, Lambiase PD. Catheter ablation for atrial fibrillation in hypertrophic cardiomyopathy: a systematic review and meta-analysis. Heart 2016; 102:1533-43. [DOI: 10.1136/heartjnl-2016-309406] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/19/2016] [Indexed: 11/04/2022] Open
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ROH SEUNGYOUNG, KIM DONGHYEOK, AHN JINHEE, LEE KWANGNO, LEE DAEIN, SHIM JAEMIN, CHOI JONGIL, PARK SANGWEON, KIM YOUNGHOON. Long-Term Outcome of Catheter Ablation for Atrial Fibrillation in Patients With Apical Hypertrophic Cardiomyopathy. J Cardiovasc Electrophysiol 2016; 27:788-95. [DOI: 10.1111/jce.12985] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 03/31/2016] [Accepted: 04/05/2016] [Indexed: 11/29/2022]
Affiliation(s)
- SEUNG-YOUNG ROH
- Division of Cardiology, Department of Internal Medicine; Korea University Medical Center; Seoul Republic of Korea
| | - DONG-HYEOK KIM
- Division of Cardiology, Department of Internal Medicine; Korea University Medical Center; Seoul Republic of Korea
| | - JINHEE AHN
- Division of Cardiology, Department of Internal Medicine; Korea University Medical Center; Seoul Republic of Korea
| | - KWANG NO LEE
- Division of Cardiology, Department of Internal Medicine; Korea University Medical Center; Seoul Republic of Korea
| | - DAE IN LEE
- Division of Cardiology, Department of Internal Medicine; Korea University Medical Center; Seoul Republic of Korea
| | - JAEMIN SHIM
- Division of Cardiology, Department of Internal Medicine; Korea University Medical Center; Seoul Republic of Korea
| | - JONG-IL CHOI
- Division of Cardiology, Department of Internal Medicine; Korea University Medical Center; Seoul Republic of Korea
| | - SANG-WEON PARK
- Division of Cardiology, Department of Internal Medicine; Sejong General Hospital; Bucheon Republic of Korea
| | - YOUNG-HOON KIM
- Division of Cardiology, Department of Internal Medicine; Korea University Medical Center; Seoul Republic of Korea
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Shelke AB, Menon R, Kapadiya A, Yalagudri S, Saggu D, Nair S, Narasimhan C. A novel approach in the use of radiofrequency catheter ablation of septal hypertrophy in hypertrophic obstructive cardiomyopathy. Indian Heart J 2016; 68:618-623. [PMID: 27773399 PMCID: PMC5079133 DOI: 10.1016/j.ihj.2016.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/30/2015] [Accepted: 02/07/2016] [Indexed: 11/30/2022] Open
Abstract
Objective Alcohol septal ablation (ASA) is a therapeutic alternative to surgical myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM). However, the anatomical variability of the septal branch, risk of complete heart block, and late onset ventricular arrhythmias are limitations to its therapeutic usage. There is recent interest in the use of radiofrequency catheter ablation (RFCA) as a therapeutic option in HOCM. We aimed to assess the safety and efficacy of RFCA in the treatment of symptomatic HOCM. Methods Seven patients with symptomatic HOCM (mean age 43.7 ± 15.6 years, five males), and significant left ventricular outflow tract (LVOT) gradient despite optimal drug therapy, underwent ablation of the hypertrophied interventricular septum. These patients had unfavorable anatomy for ASA. Ablation was performed under 3D electro-anatomical system guidance using an open irrigated tip catheter. The region of maximal LV septal bulge as seen on intracardiac echocardiography was targeted. Patients were followed up at 1, 6, and 12 months post-procedure. Results The mean baseline LVOT gradient by Doppler echocardiography was 81 ± 14.8 mm of Hg which reduced to 48.5 ± 22.6 (p = 0.0004), 49.8 ± 19.3 (p = 0.0004), and 42.8 ± 26.1 mm of Hg (p = 0.05) at 1, 6, and 12 months respectively. Symptoms improved at least by one NYHA class in all but one patient. One patient developed transient pulmonary edema post-RFA. There were no other complications. Conclusion RFCA of the hypertrophied septum causes sustained reduction in the LVOT gradient and symptomatic improvement among patients with HOCM. Electroanatomical mapping helps to perform the procedure safely.
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Affiliation(s)
- Abhijeet B Shelke
- Department of Cardiac Electrophysiology, CARE Hospitals, Hyderabad, India
| | - Rajeev Menon
- Department of Cardiology, CARE Hospitals, Hyderabad, India
| | - Anuj Kapadiya
- Department of Cardiology, CARE Hospitals, Hyderabad, India
| | - Sachin Yalagudri
- Department of Cardiac Electrophysiology, CARE Hospitals, Hyderabad, India
| | - Daljeet Saggu
- Department of Cardiac Electrophysiology, CARE Hospitals, Hyderabad, India
| | - Sandeep Nair
- Department of Cardiac Electrophysiology, CARE Hospitals, Hyderabad, India
| | - C Narasimhan
- Department of Cardiac Electrophysiology, CARE Hospitals, Hyderabad, India.
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Catheter ablation of atrial fibrillation in chronic heart failure: state-of-the-art and future perspectives. Europace 2016; 18:638-47. [DOI: 10.1093/europace/euv368] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 10/09/2015] [Indexed: 01/31/2023] Open
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Zhao DS, Shen Y, Zhang Q, Lin G, Lu YH, Chen BT, Shi LS, Huang JF, Lu HH. Outcomes of catheter ablation of atrial fibrillation in patients with hypertrophic cardiomyopathy: a systematic review and meta-analysis. Europace 2015; 18:508-20. [DOI: 10.1093/europace/euv339] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 09/09/2015] [Indexed: 11/14/2022] Open
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Sotomi Y, Inoue K, Tanaka K, Toyoshima Y, Oka T, Tanaka N, Nozato Y, Orihara Y, Koyama Y, Iwakura K, Sakata Y, Fujii K. Persistent left atrial remodeling after catheter ablation for non-paroxysmal atrial fibrillation is associated with very late recurrence. J Cardiol 2015; 66:370-6. [DOI: 10.1016/j.jjcc.2015.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 02/24/2015] [Accepted: 03/02/2015] [Indexed: 11/17/2022]
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