New Insights in the Diagnosis and Treatment of Atrial Fibrillation in Patients with Hypertrophic Obstructive Cardiomyopathy

Figure 1. Clinical case of a patient diagnosed with HOCM, who experienced paroxysmal AF episodes, showing left and right atrial remodeling and elevated filling pressures, both predisposing factors to AF development. The images present echocardiographic measurements associated with AF onset in patients with HOCM. Images (a–f) were obtained from the institutional database and were anonymized. (a) Increased LA antero-posterior diameter (≥45 mm). (b). Marked dilation of the LA area (≥28 cm2) and volume. (c,d). Elevated left ventricular filling pressures (E/e′ ratio = 17.7). (e,f). Alterations of both left and right atrial strain.

Figure 2. Clinical case of a patient diagnosed with HOCM who underwent myectomy and MV repair. Images (a–k) were obtained from the institutional database and were anonymized. (a) SAM of the MV (arrow), with significant obstruction in the LVOT. (b) M mode shows systolic anterior motion of the MV (arrow) and chordae. (c) Color Doppler image highlighting LVOT flow turbulence and moderate mitral regurgitation (arrow) secondary to SAM. (d) Severe LVOT obstruction secondary to SAM, with a peak gradient of 52 mmHg during the Valsalva maneuver. (e) Transesophageal echocardiography 3 C view showing LVOT obstruction (arrow). (f,g) CMR images demonstrate severe LV concentric hypertrophy. (h) Postoperative transthoracic echocardiography demonstrates resolution of SAM and LVOT obstruction; red arrow indicates septal myectomy, and blue arrow indicates anterior mitral leaflet plication. (i) Continuous wave Doppler shows a peak postoperative LVOT gradient of only 8 mmHg. (j) MV repair with plication of the anterior leaflet (arrow) results in loss of anterior movement of the MV. (k,l) Myectomy pieces performed at the anterior and posterior interventricular septum.