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. 2020 Nov;35(11):2957-2964.
doi: 10.1111/jocs.14946. Epub 2020 Aug 16.

Surgical ablation of atrial fibrillation in hypertrophic obstructive cardiomyopathy: Outcomes of a tailored surgical approach

Kevin Hodges  1 , Andrew Tang  1 , Carlos G Rivas  2 , Juan Umana-Pizano  1 , Raphaelle Chemtob  1 , Milind Y Desai  3 , A M Gillinov  1 , Nicholas Smedira  1 , Per Wierup  1
Affiliations

Surgical ablation of atrial fibrillation in hypertrophic obstructive cardiomyopathy: Outcomes of a tailored surgical approach

Kevin Hodges et al. J Card Surg. 2020 Nov.

Erratum in

  • Erratum.
    Hodges K, Tang A, Rivas CG, Umana-Pizano J, Chemtob R, Desai MY, Gillinov AM, Smedira N, Wierup P. Hodges K, et al. J Card Surg. 2021 Sep;36(9):3478-3479. doi: 10.1111/jocs.15669. Epub 2021 May 30. J Card Surg. 2021. PMID: 34053104 No abstract available.

Abstract

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.

Keywords: atrial fibrillation; hypertrophic cardiomyopathy; maze procedure.

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References

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