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Surgical ablation of atrial fibrillation in hypertrophic obstructive cardiomyopathy: Outcomes of a tailored surgical approach
Author(s) -
Hodges Kevin,
Tang Andrew,
Rivas Carlos G.,
UmanaPizano Juan,
Chemtob Raphaelle,
Desai Milind Y.,
Gillinov A. M.,
Smedira Nicholas,
Wierup Per
Publication year - 2020
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.14946
Subject(s) - medicine , atrial fibrillation , concomitant , pulmonary vein , cardiology , septal myectomy , ablation , ventricular outflow tract , catheter ablation , cardiomyopathy , alcohol septal ablation , surgery , heart failure , hypertrophic cardiomyopathy , obstructive cardiomyopathy
Objective To assess outcomes of concomitant ablation for atrial fibrillation (AF) in patients with preoperative AF undergoing septal myectomy for hypertrophic obstructive cardiomyopathy. Methods From 2005 to 2016, 67 patients underwent concomitant ablation for AF and septal myectomy and had a follow‐up beyond a 3‐month blanking period. Ablation strategy (pulmonary vein isolation [PVI], modified Cox‐maze III [CM‐III], or Cox‐maze IV [CM‐IV]) was tailored to preoperative AF burden, with high AF burden defined as persistent AF or need for cardioversion. AF recurrence was analyzed as a time‐related event and predictors of recurrence identified using a random forest methodology. Results A total of 38 patients (57%) had low AF burden and 29 (43%) high burden. Patients with low AF burden most frequently underwent PVI (68%). Patients with high AF burden more frequently underwent CM‐III (62%) or CM‐IV (35%). Besides the preoperative AF burden, baseline characteristics were similar between patients receiving CM‐III, CM‐IV, and PVI. After surgery, the maximum provoked left ventricular outflow tract (LVOT) gradient decreased from 99 ± 34 to 18 ± 11mm Hg ( P < .001). Eight patients (12%) required a permanent pacemaker. Cumulative AF recurrence at 1, 2, and 5 years was 11%, 22%, and 48%, respectively. Age, low preoperative resting LVOT gradient, and large left atrial diameter were predictors of AF recurrence. Conclusions Surgical outcomes of concomitant ablation for AF and septal myectomy are good, although recurrence of AF by 5 years is frequent.