Catheter ablation of atrial fibrillation in hypertrophic cardiomyopathy: A proportional meta-analysis and systematic review of single-arm studies

Azka Latif; Soban Ahmad; Muhammad Junaid Ahsan; Claire Willman; Noman Lateef; Vikas Kapoor; Sundus Ikram; Mohammad Zoraiz Ahsan; Jason Meyers; Michael H Kim

doi:10.1016/j.hroo.2023.01.002

Catheter ablation of atrial fibrillation in hypertrophic cardiomyopathy: A proportional meta-analysis and systematic review of single-arm studies

Heart Rhythm O2. 2023 Jan 13;4(4):258-267. doi: 10.1016/j.hroo.2023.01.002. eCollection 2023 Apr.

Authors

Affiliations

¹ Department of Cardiovascular Disease, Baylor University, Houston, Texas.
² Department of Internal Medicine, East Carolina University, Greenville, North Carolina.
³ Department of Cardiovascular Disease, MercyOne Medical Center, Des Moines, Iowa.
⁴ Department of Cardiovascular Disease, Creighton University, Omaha, Nebraska.
⁵ Department of Cardiovascular Disease, University of Nebraska Medical Center, Omaha, Nebraska.
⁶ Department of Internal Medicine, SEGi University, Petaling Jaya, Malaysia.
⁷ Department of Internal Medicine, Fatima Memorial Hospital, Lahore, Pakistan.

Abstract

Background: Atrial fibrillation (AF) is the most common arrhythmia in patients with hypertrophic cardiomyopathy (HCM). Limited data exists about the efficacy and clinical outcomes of AF ablation in HCM.

Objective: The purpose of this meta-analysis was to evaluate the role of catheter-based ablation for treatment of AF in patients with HCM.

Methods: PubMed, SCOPUS, Web of Science, Embase, Cochrane library, and ClinicalTrials.gov were searched for studies discussing outcomes of catheter-based ablation for AF in patients with HCM. Two reviewers independently screened studies and extracted relevant data. Incidence rate estimates from individual studies underwent logit transformation to calculate the weighted summary proportion under the random effect model.

Results: A total of 19 reports met the inclusion criteria (1183 patients). The single ablation procedure was successful in 39% patients. Up to 34% patients underwent a repeat ablation. About 41% patients in normal sinus rhythm after successful AF ablation received postprocedure antiarrhythmic drug (AAD) therapy. Patients undergoing successful AF ablation experienced a significant improvement in the New York Heart Association functional class (standardized mean difference -1.03; 95% confidence interval -1.23 to -0.83; P < .00001).

Conclusion: AF ablation appears to be safe and feasible in patients with HCM. Freedom from AF after undergoing successful ablation is associated with significant improvement in heart failure symptoms.

Keywords: Ablation; Antiarrhythmic drugs; Atrial fibrillation; Catheter ablation; Hypertrophic cardiomyopathy.