Complete pulmonary vein isolation guided by three-dimensional electroanatomical mapping for the treatment of paroxysmal atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy

AIMS: Evaluation of the clinical outcome of patients with hypertrophic obstructive cardiomyopathy (HOCM) and paroxysmal atrial fibrillation (AF) treated with complete pulmonary vein (PV) isolation guided by three-dimensional (3-D) electroanatomical (EA) mapping. METHODS: Circumferential radiofrequency (RF) ablation and continuous circular lesions (CCLs) around the left and right-sided PVs were performed in 4 highly symptomatic patients (2 males; age 57.5 +/- 8.3 years) with HOCM and anti-arrhythmic drug (AAD) refractory paroxysmal AF. Ablation was guided by 3-D EA mapping combined with conventional circumferential PV mapping. The endpoints of the ablation were defined as: (1) absence of all PV spikes documented with the two Lasso catheters within the ipsilateral PVs; and (2) no recurrence of the PV spikes within all PVs following intravenous administration of adenosine. RESULTS: The ablation endpoints were achieved in all patients. A repeat ablation was performed in one patient due to repetitive atrial tachycardia, 1 month after the initial procedure. During a follow-up of 5.8 +/- 2.7 months, all patients are free of AF recurrence. Short episodes of symptomatic AT were documented after the repeat procedure, and were well controlled with oral amiodarone in the patient. No procedure-related complications were observed. CONCLUSION: The present study demonstrates that complete isolation of ipsilateral PVs guided by 3-D EA mapping is potentially effective for the treatment of highly symptomatic, drug refractory paroxysmal AF in patients with HOCM.