Key result
Cryoballoon ablation failed to maintain sinus rhythm in all 4 patients with hypertrophic cardiomyopathy, who all experienced early atrial fibrillation recurrences, compared to 80% stable sinus rhythm in non-HCM patients.
Why the study?
Does cryoballoon ablation prevent atrial fibrillation recurrence in patients with hypertrophic cardiomyopathy compared to non-HCM patients?
Observational (n=166)
No
Does cryoballoon ablation prevent atrial fibrillation recurrence in patients with hypertrophic cardiomyopathy compared to non-HCM patients?
Absolute Event Rate: 0% vs 80%
Cryoballoon ablation is not recommended for maintaining sinus rhythm in patients with hypertrophic cardiomyopathy and atrial fibrillation due to a high rate of early recurrences.
May support cryoballoon PVI feasibility in HCM-related AF; hypothesis-generating and requires prospective validation.
BACKGROUND: Atrial fibrillation (AF) represents a turning point in hypertrophic cardiomyopathy (HCM). Pulmonary Vein Isolation (PVI) with Radiofrequency Catheter Ablation (RFCA) is accepted to be successful in restoring sinus rhythm (SR) in HCM patients. The efficacy of cryoballoon (CB) therapy in HCM patients has not been studied so far. METHODS: 166 patients with AF underwent PVI with CB technology in our single center between 1/2012 and 12/2015. To evaluate the efficacy of the CB therapy in HCM patients, we compared their clinical outcome with those in "Non-HCM" AF patients in a 3 and 6 months follow-up. RESULTS: Out of 166 AF patients (65.7% paroxysmal AF, PAF), 4 patients had HCM and PAF (young males < 50 years). During the blanking period, 26 patients (15.8%) suffered from AF recurrence (11.0% PAF), including all HCM patients. The 6 months follow up of "Non-HCM" AF patients showed acceptable results (80% stable SR), whereas the HCM patients remained AF. IN CONCLUSION: Even if the CB provides advantages, the single device cannot be recommended in HCM patients because of early AF recurrences. Anyway, because of the specific hemodynamic changes in HCM patients with AF, ablation should be sought in an early state of its occurrence, then, however, preferably with RFCA.
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Maagh et al. (2016) conducted an observational in Atrial fibrillation with and without hypertrophic cardiomyopathy (n=166). Cryoballoon ablation in HCM patients vs. Cryoballoon ablation in non-HCM patients was evaluated on Stable sinus rhythm at 6 months. Cryoballoon ablation failed to maintain sinus rhythm in all 4 patients with hypertrophic cardiomyopathy, who all experienced early atrial fibrillation recurrences, compared to 80% stable sinus rhythm in non-HCM patients.
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