Atrial fibrillation management during septal myectomy for hypertrophic cardiomyopathy: A systematic review

Introduction Atrial fibrillation is common in patients with hypertrophic cardiomyopathy, and significantly impacts mortality and morbidity. In patients with atrial fibrillation undergoing septal myectomy, concomitant surgery for atrial fibrillation may improve outcomes. Methods A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All studies reporting the outcomes of combined septal myectomy and atrial fibrillation surgery were included. Results A total of 10 observational studies were identified, including 644 patients. Most patients had paroxysmal atrial fibrillation. The proportion with prior unsuccessful ablation ranged from 0 to 19%, and preoperative left atrial diameter ranged from 44 ± 17 to 52 ± 8 mm. Cox–Maze IV (n = 311) was the most common technique used, followed by pulmonary vein isolation (n = 222) and Cox–Maze III (n = 98). Patients with persistent or longstanding atrial fibrillation more frequently received Cox–Maze III/IV. Ranges of early postoperative outcomes included: mortality 0 to 7%, recurrence of atrial tachyarrhythmias 4.4 to 48%, cerebrovascular events 0 to 1.5%, and pacemaker insertion 3 to 21%. Long-term data was limited. Freedom from atrial tachyarrhythmias at 1 year ranged from 74% to 96%, and at 5 years from 52% to 100%. Preoperative predictors of late atrial tachyarrhythmia recurrence included left atrial diameter >45 mm, persistent or longstanding preoperative atrial fibrillation and longer atrial fibrillation duration. Conclusion In patients with atrial fibrillation undergoing septal myectomy, the addition of ablation surgery adds low overall risk to the procedure, and likely reduces the risk of recurrent atrial fibrillation in the long term. Future randomised studies comparing septal myectomy with or without concomitant AF ablation are needed.

Download Full-text

P1766Clinical impact of atrial fibrillation and heart failure in a cohort of patients with hypertrophic cardiomyopathy

European Heart Journal ◽

10.1093/eurheartj/ehz748.0519 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

I Esteve Ruiz ◽

H Llamas Gomez ◽

I M Esteve Ruiz ◽

M J Romero Reyes ◽

R Pavon Jimenez ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Atrial Fibrillation ◽

Hypertrophic Cardiomyopathy ◽

Left Atrial ◽

Left Ventricular ◽

Left Atrial Diameter ◽

Myocardial Thickness ◽

Worse Prognosis ◽

Echocardiographic Findings

Abstract Background Atrial fibrillation (AF) and heart failure (HF) are common complications in Hypertrophic Cardiomyopathy (HCM) patients, leading to a worsening of their quality of life, need of hospitalization and prognosis. Purpose To analyze clinical variables associated with the presence of AF and HF in HCM patients. Methods HCM patients followed-up in cardiological visits from 2005 to 2017 were included and a descriptive analysis of those with AF and HF was performed. Results Out of 168 patients, 28% had reported AF. They were older than those without arrhythmia (68±15 years (yrs) vs 56±20 yrs, p<0.001) and had more comorbidities such as diabetes (27.7% vs 12.4%, p=0.02) and chronic renal disease (21.3% vs 6.6%, p=0.006). Echocardiographic findings are summarized in Table 1. In our cohort, 27.4% of the patients had HF with a functional class according to the New York Heart Association criteria ≥2. They were older than those without HF (69.3±11.6 yrs vs 55.9±20.6 yrs, p<0.001) and had higher rate of cardiovascular (CV) risk factors such as hypertension (65.2% vs 44.3%, p=0.015). The presence of HF was directly associated with the presence of AF: 52.2% of the patients with HF and 18.9% of the patients without HF developed this arrhythmia (p<0.001). HF patients associated larger left atrial diameter (48±8.1 vs 41.6±7.2mm, p<0.001), myocardial thickness (21.7±3.9 vs 19.2±5.8mm, p=0.002) and higher left ventricular outflow obstruction (LVOO) (55±32 vs 34.3±31.3mmHg, p=0.021), without any differences in the left ventricular ejection fraction. HF patients had a worse prognosis (Picture 1). Multivariate analysis showed that the presence of AF (OR 2.6, CI 95% 1.1–6.3) and LVOO (OR 4.8, CI 95% 1.5–14.8) were independent risk factors of developing HF. Table 1. Echocardiographic findings AF (n=47) Non AF (n=121) p LVOO 27.7 19 0.22 Aortic regurgitation 12.8 3.3 0.02 Mitral regurgitation 27.7 12.4 0.02 Left atrial diameter (mm) 48.8±7.2 40.7±7 <0.001 Myocardial thickness (mm) 20±5.4 19±5.2 0.02 Qualitative variables are expressed as percentages (%) and quantitative variables as mean and standard deviation (M ± SD). Picture 1. Main outcomes of HF patients Conclusions AF and HF were directly associated in our cohort, especially in elderly patients with higher comorbidities, leading to a worse prognosis with a higher hospitalization rate and CV death. This emphasizes the importance of a thorough search of both complications in order to initiate early treatment and improve the prognosis of HCM patients.

Download Full-text

Left atrial appendage closure for atrial fibrillation in a patient with hypertrophic cardiomyopathy in whom long-term oral anticoagulation was not feasible

Advances in Interventional Cardiology ◽

10.5114/aic.2019.87901 ◽

2019 ◽

Vol 15 (3) ◽

pp. 380-381

Author(s):

Mariusz Kłopotowski ◽

Marek Konka ◽

Marcin Demkow ◽

Krzysztof Kukula ◽

Adam Witkowski

Keyword(s):

Atrial Fibrillation ◽

Hypertrophic Cardiomyopathy ◽

Oral Anticoagulation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Left Atrial Appendage Closure

Download Full-text

Predictors of Failure Cardioversion for Recurrent Atrial Fibrillation Following Mitral Valve Surgery With Ablation

The Heart Surgery Forum ◽

10.1532/hsf.2997 ◽

2020 ◽

Vol 23 (3) ◽

pp. E300-E304

Author(s):

Hailong Cao ◽

Xin Chen ◽

Xiyu Zhu ◽

Yining Yang ◽

Qing Zhou ◽

...

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Mitral Valve ◽

Atrial Flutter ◽

Left Atrial ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Loading Dose ◽

Left Atrial Diameter ◽

Recurrent Atrial Fibrillation

Background: Electrical cardioversion (ECV) often is required for terminating recurrent atrial fibrillation (AF) after surgical radiofrequency ablation in patients undergoing mitral valve surgery. However, ECV is unsuccessful in some cases. In this study, we aimed to identify possible predictors of failed ECV for recurrent atrial fibrillation following mitral valve surgery with concomitant radiofrequency ablation. Methods: We enrolled 1,136 persistent AF patients with history of mitral valve surgery and concomitant radiofrequency ablation. Three-hundred-nineteen patients experienced recurrence of persistent AF and received ECV therapy. Comparison was made between patients with failed ECV (Failure group, N = 68) and successful ECV (Success group, N = 251). Results: In multivariate regression analysis, age, pre-ECV loading-dose amiodarone, left atrial diameter, atrial flutter and time from surgery to ECV were independent predictors for outcomes of ECV. According to receiver operating characteristic curve analysis, the best threshold values of age, left atrial diameter and time from surgery to ECV for predicting failed ECV were 55.5 years, 64.5 mm, and 90.5 days, respectively. Conclusion: Older age, larger left atrium and longer time from surgery to ECV are independent predictors for failed ECV in this group. Compared with AF, atrial flutter is easier to be successfully terminated by ECV. Pre-ECV loading-dose amiodarone is helpful for successful ECV. These findings have important implications for identifying the kinds of patients to receive effective ECV.

Download Full-text

P1767Prevalence and clinical significance of sleep-disordered breathing in patients with hypertrophic cardiomyopathy

European Heart Journal ◽

10.1093/eurheartj/ehz748.0520 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Potratz ◽

H Fox ◽

L Faber ◽

...

Keyword(s):

Atrial Fibrillation ◽

Hypertrophic Cardiomyopathy ◽

Clinical Significance ◽

Left Atrial ◽

Sleep Disordered Breathing ◽

Clinical Aspects ◽

Apnea Hypopnea Index ◽

Left Atrial Diameter ◽

Large Patient ◽

Disordered Breathing

Abstract Background Despite major advances in knowledge on hypertrophic cardiomyopathy (HCM) at the genetic and molecular levels, the understanding of essential clinical aspects remains limited. The aim of this study is to identify the prevalence and clinical significance of Sleep-disordered Breathing (SDB) in a large patient population. Methods 201 patients (78 women, age 64±15 years) with HCM were screened for obstructive (OSA) or central (CSA) sleep-disordered breathing using multichannel cardiorespiratory polygraphy. Additionally, patients received a spiroergometric examination and echocardiography. SDB was defined as apnea-hypopnea index (AHI) ≥5/h and OSA/CSA differentiated after the majority of events. Results SDB was documented in 60% of all patients. OSA was diagnosed in 71 patients (35.3%) and CSA in 44 (21.9%) patients. SDB requiring treatment was found in 106 (52.7%) patients. In patients with AHI ≥15/h NYHA class was increased (2.1 vs. 2.39, p=0.04) and maximal O2 uptake during exercise was lower (20.1 vs. 16.1 p<0.001). Also left atrial diameter was significantly larger (46.9 mm vs. 50.41 mm, p=0.01) and rate of atrial fibrillation was increased (0.5 vs. 0.72 p=0.03). CSA pts had a larger left atrial diameter compared to pts with OSA (52.13 mm vs. 47.82 mm, p=0.02). Conclusion There is a high prevalence of SDB in HCM patients. Patients with moderate to severe SDB showed increased atrial fibrillation incidence and reduced cardiopulmonary performance. Whether the SDB has an independent prognostic relevance in patients with HCM needs to be elucidated.

Download Full-text

LEFT ATRIAL VOLUME INDEX ASSOCIATED WITH RECURRENT ATRIAL FIBRILLATION AFTER ELECTRICAL CARDIOVERSION: META-ANALYSIS AND SYSTEMATIC REVIEW

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)01632-6 ◽

2021 ◽

Vol 77 (18) ◽

pp. 273

Author(s):

Sittinun Thangjui ◽

Ratdanai Yodsuwan ◽

Jakrin Kewcharoen ◽

Angkawipa Trongtorsak

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Left Atrial ◽

Meta Analysis ◽

Left Atrial Volume ◽

Electrical Cardioversion ◽

Volume Index ◽

Atrial Volume ◽

Left Atrial Volume Index ◽

Recurrent Atrial Fibrillation

Download Full-text

Catheter Ablation vs. Anti-Arrhythmic Drugs as First-Line Treatment in Symptomatic Paroxysmal Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.664647 ◽

2021 ◽

Vol 8 ◽

Author(s):

Andrea Saglietto ◽

Fiorenzo Gaita ◽

Roberto De Ponti ◽

Gaetano Maria De Ferrari ◽

Matteo Anselmino

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Clinical Trials ◽

Catheter Ablation ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Rhythm Control ◽

First Line ◽

Atrial Tachyarrhythmias

Background: Catheter ablation has become a well-established indication for long-term rhythm control in atrial fibrillation (AF) patients refractory to anti-arrhythmic drugs (AADs). Efficacy and safety of AF catheter ablation (AFCA) before AADs failure are, instead, questioned.Objective: The aim of the study was to perform a systematic review and meta-analysis of randomized clinical trials (RCTs) comparing first-line AFCA with AADs in symptomatic patients with paroxysmal AF.Methods: We performed a random-effects meta-analysis of binary outcome events comparing AFCA with AADs in rhythm control-naïve patients. The primary outcomes, also stratified by the type of ablation energy (radiofrequency or cryoenergy), were (1) recurrence of atrial tachyarrhythmias and (2) recurrence of symptomatic atrial tachyarrhythmias. The secondary outcomes included adverse events.Results: Six RCTs were included in the analysis. AFCA was associated with lower recurrences of atrial tachyarrhythmias [relative risk (RR) 0.58, 95% confidence interval (CI) 0.46–0.72], consistent across the two types of ablation energy (radiofrequency, RR 0.50, 95% CI 0.28–0.89; cryoenergy, RR 0.60, 95% CI 0.50–0.72; p-value for subgroup differences: 0.55). Similarly, AFCA was related to less symptomatic arrhythmic recurrences (RR 0.46, 95% CI 0.27–0.79). Overall, adverse events did not differ. A trend toward increased periprocedural cardiac tamponade or phrenic nerve palsy was observed in the AFCA group, while more atrial flutter episodes with 1:1 atrioventricular conduction and syncopal events were reported in the AAD group.Conclusions: First-line rhythm control therapy with AFCA, independent from the adopted energy source (radiofrequency or cryoenergy), reduces long-term arrhythmic recurrences in patients with symptomatic paroxysmal AF compared with AADs.

Download Full-text