Ablation of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy: Treatment Strategy, Characteristics of Consecutive Atrial Tachycardia and Long-Term Outcome.
Ablation of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy: Treatment Strategy, Characteristics of Consecutive Atrial Tachycardia and Long-Term Outcome.
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DOI：
10.1161/jaha.120.017451
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发表时间：
2021-02-02
影响因子：
5.4
通讯作者：
Meyer C
中科院分区：
文献类型：
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作者：
Dinshaw L;Münkler P;Schäffer B;Klatt N;Jungen C;Dickow J;Tamenang A;Schleberger R;Pecha S;Pinnschmidt H;Patten M;Reichenspurner H;Willems S;Meyer C
心房颤动（AF）在肥厚型心肌病（HCM）患者中很常见，并与临床状态恶化相关。症状性房颤的消融是一种既定的治疗方法，但在HCM中，复发性房性心律失常的特征和长期结局尚不确定。65例HCM患者（年龄64.5±9.9岁，42例[64.6%]男性）接受了AF消融术。消融策略包括所有患者的肺静脉隔离和消融复杂碎裂心房电图或随后的房性心动过速（AT）（如适用）。分别有13例（20.0%）、51例（78.5%）和1例（1.5%）患者出现阵发性、持续性AF和原发性AT。25例（38.4%）患者发生AT，共计54例AT。15例（23.1%）患者观察到稳定AT，10例（15.3%）患者观察到不稳定AT。37例（68.5%）房性心动过速的机制特征为大折返，12例（22.2%）为局部折返，1例（1.9%）为局灶性机制，4例（7.4%）房性心动过速未分类。在1.9±1.2次消融术和48.1±32.5个月的随访后，60.0%的患者证实无AF/AT复发。阵发性房颤和持续性房颤的无复发率分别为84.6%和52.9%（P<0.01）。24例（36.9%）患者维持抗肿瘤药物治疗。HCM患者的AF消融术可有效进行长期心律控制，尤其是接受肺静脉隔离的阵发性AF患者具有良好的临床结局。在HCM中经常观察到AF消融后的AT。即使抗心律失常药物治疗的使用率仍然很高，但在合理数量的患者中，通过持续性房颤消融可以实现房性心律失常的自由。
Atrial fibrillation (AF) is common in patients with hypertrophic cardiomyopathy (HCM) and is associated with a deterioration of clinical status. Ablation of symptomatic AF is an established therapy, but in HCM, the characteristics of recurrent atrial arrhythmias and the long‐term outcome are uncertain. Sixty‐five patients with HCM (aged 64.5±9.9 years, 42 [64.6%] men) underwent AF ablation. The ablation strategy included pulmonary vein isolation in all patients and ablation of complex fractionated atrial electrograms or subsequent atrial tachycardias (AT) if appropriate. Paroxysmal, persistent AF, and a primary AT was present in 13 (20.0%), 51 (78.5%), and 1 (1.5%) patients, respectively. Twenty‐five (38.4%) patients developed AT with a total number of 54 ATs. Stable AT was observed in 15 (23.1%) and unstable AT in 10 (15.3%) patients. The mechanism was characterized as a macroreentry in 37 (68.5%), as a localized reentry in 12 (22.2%), a focal mechanism in 1 (1.9%), and not classified in 4 (7.4%) ATs. After 1.9±1.2 ablation procedures and a follow‐up of 48.1±32.5 months, freedom of AF/AT recurrences was demonstrated in 60.0% of patients. No recurrences occurred in 84.6% and 52.9% of patients with paroxysmal and persistent AF, respectively (P<0.01). Antiarrhythmic drug therapy was maintained in 24 (36.9%) patients. AF ablation in patients with HCM is effective for long‐term rhythm control, and especially patients with paroxysmal AF undergoing pulmonary vein isolation have a good clinical outcome. ATs after AF ablation are frequently observed in HCM. Freedom of atrial arrhythmia is achieved by persistent AF ablation in a reasonable number of patients even though the use of antiarrhythmic drug therapy remains high.