Characteristics and long-term ablation outcomes of supraventricular arrhythmias in hypertrophic cardiomyopathy: a 10-year, single-center experience

Abstract Background A variety of supraventricular arrhythmias (SVAs) may occur in patients with hypertrophic cardiomyopathy (HCM). The characteristics and long-term ablation outcomes of different types of SVAs in HCM have not been comprehensively investigated. Methods We retrospectively enrolled 101 consecutive symptomatic HCM patients with suspected arrhythmia from May 2010 to October 2020. The clinical features and ablation outcomes of patients with SVAs were further analyzed. Results Seventy-eight patients had SVAs, consisting of 50 (64.1%) atrial fibrillation (AF), 16 (20.5%) atrial flutter (AFL), 15 (19.2%) atrioventricular reentrant tachycardia (AVRT), 11 (14.1%) atrial arrhythmia (AT), and 3 (3.8%) atrioventricular nodal reentrant tachycardia (AVNRT). Thirty-four patients underwent catheter ablation including 14 for AF, 9 for AVRT, 6 for AFL, 3 for AVNRT, 1 for both AF and AFL, and 1 for both AF and AVRT. They were followed up for a median (interquartile range) of 58.5 (82.9) months. There were no recurrences for patients with non-AF SVAs. For patients with AF, the 1- and 7-year AF-free survival were 87.5% and 49.5%, respectively. A ROC analysis revealed that a greater left ventricular end-diastolic dimension (LVEDD) was associated with higher recurrence of AF with an optimum cutoff value of 47mm (c-statistic = 0.91, p=0.011, sensitivity = 1.00, specificity = 0.82). In Kaplan-Meier analysis, patients with LVEDD ≥47mm had worse AF-free survival (log-rank p=0.014). Conclusions AF is the most common SVA in HCM, with AFL, AVRT, AT, and AVNRT ranking the second to the last according to the prevalence. The long-term catheter ablation outcome for non-AF SVAs in HCM is satisfying. A greater LVEDD predicts AF recurrence after catheter ablation in patients with HCM. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): National Natural Science Foundation of China Figure 1 Figure 2

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Characteristics and Long-Term Ablation Outcomes of Supraventricular Arrhythmias in Hypertrophic Cardiomyopathy: A 10-Year, Single-Center Experience

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.766571 ◽

2021 ◽

Vol 8 ◽

Author(s):

Hong-Da Zhang ◽

Lei Ding ◽

Si-Xian Weng ◽

Bin Zhou ◽

Xiao-Tong Ding ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Catheter Ablation ◽

Left Ventricular ◽

Atrioventricular Nodal Reentrant Tachycardia ◽

Supraventricular Arrhythmias ◽

Reentrant Tachycardia ◽

Characteristic Analysis ◽

Free Survival ◽

Atrioventricular Reentrant Tachycardia

Background: A variety of supraventricular arrhythmias (SVAs) may occur in patients with hypertrophic cardiomyopathy (HCM). The characteristics and long-term ablation outcomes of different types of SVAs in HCM have not been comprehensively investigated.Methods: We retrospectively enrolled 101 consecutive patients with HCM who were referred to the electrophysiology and arrhythmia service from May 2010 to October 2020. The clinical features and ablation outcomes were analyzed.Results: Seventy-eight patients had SVAs, which comprised 50 (64.1%) cases of atrial fibrillation (AF), 16 (20.5%) of atrial flutter (AFL), 15 (19.2%) of atrioventricular reentrant tachycardia (AVRT), 11 (14.1%) of atrial arrhythmia (AT), and 3 (3.8%) of atrioventricular nodal reentrant tachycardia (AVNRT). Thirty-four patients underwent catheter ablation and were followed up for a median (interquartile range) of 58.5 (82.9) months. There was no recurrence in patients with non-AF SVAs. In patients with AF, the 1- and 7-year AF-free survival rates were 87.5 and 49.5%, respectively. A receiver operator characteristic analysis showed that a greater left ventricular end-diastolic dimension (LVEDD) was associated with a higher recurrence of AF, with an optimum cutoff value of 47 mm (c-statistic = 0.91, p = 0.011, sensitivity = 1.00, specificity = 0.82). In Kaplan–Meier analysis, patients with a LVEDD ≥ 47 mm had worse AF-free survival than those with a LVEDD <47 mm (log-rank p = 0.014).Conclusions: In this unique population of HCM, AF was the most common SVA, followed in order by AFL, AVRT, AT, and AVNRT. The long-term catheter ablation outcome for non-AF SVAs in HCM is satisfactory. A greater LVEDD predicts AF recurrence after catheter ablation in patients with HCM.

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Abstract 13729: Surgical Myectomy Results in Significantly Improved Long-term Event Rate in Hypertrophic Cardiomyopathy Patients With Severe Left Ventricular Outflow Tract Obstruction

Circulation ◽

10.1161/circ.130.suppl_2.13729 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Milind Y Desai ◽

Nicholas G Smedira ◽

Aditya Bhonsale ◽

Nitesh Ainani ◽

Maran THamilarasan ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Left Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Outflow Tract ◽

Long Term Outcomes ◽

Free Survival ◽

Left Ventricular Outflow ◽

Surgical Myectomy

Background: In hypertrophic cardiomyopathy (HCM) with severe left ventricular outflow tract obstruction (LVOTO), surgical myectomy (SM) performed for relief of intractable symptoms is safe and associated with excellent long-term symptom-free survival. In such patients, we sought to determine if SM also results in improvement of long-term outcomes. Methods: We studied 1530 HCM patients with severe LVOTO (50±13 years, 63% men) that were evaluated at our center [excluding <18 years of age, LV ejection fraction (LVEF) <50%, LVOT gradient <30 mm Hg). Clinical, echocardiographic and surgical data were recorded. A composite endpoint of death and/or implantable defibrillator (ICD) discharge was recorded. Results: Hypertension, coronary artery disease (CAD), family history of HCM and syncope were present in 41%, 15%, 17% and 18%, while 73% patients were in Functional Class (FC) ≥ II. Mean LVEF, basal septal thickness, LVOT gradient (resting or provocable) and indexed left atrial dimensions were 62±5%, 2.2±1 cm, 101±39 mm Hg, 2.2±0.4 cm/m2. During 8±6 years of follow-up, 990 (65%) patients underwent SM (of which 65% were isolated SM), while 540 (35%) did not. 94 (6%) patients had alcohol septal ablation (66 in the non myectomy group), while 18% developed atrial fibrillation (AF), and 18% had ICD. There were 169 (11%) events (151 deaths), with 0% 30-day mortality in the SM group. On stepwise multivariable Cox Proportional Hazard analysis, increasing age (Hazard Ratio or HR 1.22 [1.06-1.40]), CAD (HR 1.57 [1.06-2.33]), worsening FC (HR 1.34 [1.05-1.71]) and AF (HR 1.73 [1.23-2.43]) predicted higher events, while SM as a time-dependent covariate (HR 0.58 [0.41-0.81]) was associated with improved event-free survival (all p<0.01). Kaplan-Meier curve showing impact of SM on outcomes is shown in Figure. Conclusion: In HCM patients with severe LVOTO, SM is associated with significant improvement in long-term outcomes when compared to watchful waiting.

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Introduction

ESC CardioMed ◽

10.1093/med/9780198784906.003.0475 ◽

2018 ◽

pp. 2049-2050

Author(s):

Carina Blomström-Lundqvist

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Atrial Tachycardia ◽

Atrioventricular Node ◽

Supraventricular Arrhythmia ◽

Atrioventricular Nodal Reentrant Tachycardia ◽

Reentrant Tachycardia ◽

Atrioventricular Reentrant Tachycardia ◽

Dc Cardioversion ◽

Premature Beats

Supraventricular arrhythmias encompass atrial premature beats, supraventricular tachycardias (SVTs), and atrial fibrillation. SVT is used to describe tachycardias in which the mechanism involves tissue from the His bundle or above, thus including atrial tachycardias, atrioventricular nodal reentrant tachycardia, and atrioventricular reentrant tachycardia due to accessory pathways. Atrial fibrillation is not included among the SVTs and is described elsewhere. The term tachycardia refers to atrial and/or ventricular rates greater than 100 beats per minute at rest. Atrial premature beats, the most common supraventricular arrhythmia, can be seen in Holter recordings in the majority of healthy individuals, and increase in frequency with age and presence of structural heart disease. Paroxysmal SVTs that can be terminated by vagal manoeuvres are usually reentrant tachycardias involving the atrioventricular node, such as atrioventricular nodal reentrant tachycardia or atrioventricular reentrant tachycardia. Symptoms may result in a poor quality of life. Rarely, patients with the Wolff–Parkinson–White syndrome develop atrial fibrillation that may degenerate into ventricular fibrillation in case the anterograde refractory period of the accessory pathway is very short and permanent forms of SVTs result in tachycardiomyopathy with left ventricular dysfunction. Paroxysmal SVT can be terminated by vagal manoeuvres, adenosine, overdrive pacing, and DC cardioversion. Atrial flutter, the most common atrial tachycardia, is a macro-reentrant atrial tachycardia that can be terminated by drugs, overdrive atrial pacing, and DC cardioversion. Most SVTs can be successfully treated by catheter ablation facilitated by modern electroanatomical mapping systems. Long-term antiarrhythmic drug therapy may be required for patients who are not suitable for or cured by catheter ablation.

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Radiofrequency Catheter Ablation of Coexistent Idiopathic Left Ventricular Tachycardia and Atrioventricular Nodal Reentrant Tachycardia

Journal of the Chinese Medical Association ◽

10.1016/s1726-4901(09)70078-4 ◽

2005 ◽

Vol 68 (10) ◽

pp. 479-483 ◽

Cited By ~ 4

Author(s):

Ken-Pen Weng ◽

Chuen-Wang Chiou ◽

Ming-Ho Kung ◽

Chu-Chuan Lin ◽

Kai-Sheng Hsieh

Keyword(s):

Ventricular Tachycardia ◽

Catheter Ablation ◽

Radiofrequency Catheter Ablation ◽

Left Ventricular ◽

Atrioventricular Nodal Reentrant Tachycardia ◽

Reentrant Tachycardia ◽

Idiopathic Left Ventricular Tachycardia

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Long-Term Follow-Up After Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia in Children

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.116.004264 ◽

2016 ◽

Vol 9 (11) ◽

Cited By ~ 18

Author(s):

David Backhoff ◽

Sophia Klehs ◽

Matthias J. Müller ◽

Heike E. Schneider ◽

Thomas Kriebel ◽

...

Keyword(s):

Catheter Ablation ◽

Atrioventricular Nodal Reentrant Tachycardia ◽

Reentrant Tachycardia ◽

Long Term Follow Up

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P5699Endocardial vs. epicardial ventricular tachycardia ablation: a propensity score matched analysis

European Heart Journal ◽

10.1093/eurheartj/ehz746.0641 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

D J Nascimento Matos ◽

D Cavaco ◽

P Freitas ◽

A M Ferreira ◽

G Rodrigues ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Catheter Ablation ◽

Propensity Score ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Drug Resistant ◽

Ventricular Ejection Fraction ◽

Free Survival ◽

Ventricular Tachycardia Ablation

Abstract Introduction Direct comparisons of long-term clinical outcomes of endocardial vs. epicardial catheter ablation techniques for drug-resistant ventricular tachycardia (VT) have been scarcely reported. We aim to compare the long-term efficacy and safety of endocardial vs. epicardial catheter ablation (END-ABL and EPI-ABL, respectively) in a propensity score (PS) matched population. Methods Single-center observational registry including 215 consecutive patients who underwent END-ABL (181) or EPI-ABL (n=34) for drug-resistant VT between January 2007 and June 2018. Efficacy endpoint was defined as VT-free survival after catheter ablation, while safety outcomes were defined by 30-days mortality and procedure-related complications. A propensity score was used to match patients in a 1:1 fashion according to the following variables: VT storm at presentation, left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) class III/IV at presentation, ischemic ethology, presence of implantable cardioverter-defibrillator (ICD), and previous endocardial catheter ablation. Independent predictors of VT recurrence were assessed by Cox regression. Results The PS yielded two groups of 31 patients each well matched for baseline characteristics (Table 1). Over a median follow-up of 2 years (IQR 1–3), 58% (n=18) ENDO-ABL patients had VT recurrence vs. 26% (n=8) in the EPI-ABL group (P=0.020). The yearly rates of VT recurrence were 28%/year for END-ABL vs. 11%/year for EPI-ABL (P=0.021). Multivariate survival analysis identified previous endocardial ablation (HR= 3.52; 95% CI 1.17–10.54, p=0.026) and VT storm at presentation (HR=3.57; 95% CI 1.50–8.50, p=0.004) as independent predictors of VT recurrence. EPI-ABL was independently associated with fewer VT recurrences (HR=0.28; 95 CI 0.12–0.69, p=0.005), but only in patients with a previous endocardial ablation (p for interaction = 0.004) – Figure A. No patients died at 30-days post-procedure. Hospital length of stay was similar between END-ABL and EPI-ABL (5 vs. 4 days respectively, p=0.139), as was the complication rate (6.5% vs. 12.9% respectively, p=0.390), although driven by different causes (Table 1). Conclusion VT storm at presentation and previous catheter ablation were independent predictors of VT recurrence. In patients with a previous failed endocardial catheter ablation, epicardial ablation seems to provide greater VT-free survival than repeat endocardial ablation. Both strategies seem equally safe.

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