Does ablation of atrial fibrillation at the time of septal myectomy improve survival of patients with obstructive hypertrophic cardiomyopathy

Published on Mar 1, 2021in The Journal of Thoracic and Cardiovascular Surgery4.451
· DOI :10.1016/J.JTCVS.2020.08.066
Hao Cui4
Estimated H-index: 4
(Mayo Clinic),
Hartzell V. Schaff131
Estimated H-index: 131
(Mayo Clinic)
+ 5 AuthorsSteve R. Ommen78
Estimated H-index: 78
(Mayo Clinic)
Sources
Abstract
Abstract Objective To evaluate the outcomes after septal myectomy in patients with obstructive hypertrophic cardiomyopathy according to atrial fibrillation and surgical ablation of atrial fibrillation. Methods We reviewed patients with obstructive hypertrophic cardiomyopathy who underwent septal myectomy at the Mayo Clinic from 2001 to 2016. History of atrial fibrillation was obtained from patient histories and electrocardiograms. All-cause mortality was the primary end point. Results A total of 2023 patients underwent septal myectomy, of whom 394 (19.5%) had at least 1 episode of atrial fibrillation preoperatively. Among patients with atrial fibrillation, 76 (19.3%) had only 1 known episode, 278 (70.6%) had recurrent paroxysmal atrial fibrillation, and 40 (10.2%) had persistent atrial fibrillation. Surgical ablation was performed in 190 patients at the time of septal myectomy, including 148 with pulmonary vein isolation and 42 with the classic maze procedure. Among all patients, operative mortality was 0.4%, and there were no early deaths in patients undergoing surgical ablation. Over a median follow-up of 5.6 years, patients with preoperative atrial fibrillation had increased mortality (hazard ratio, 1.36; 95% confidence interval, 0.97-1.91; P = .070) after multivariable adjustment for comorbidities. When considering the impact of atrial fibrillation with or without surgical treatment, the adjusted hazard ratio for mortality in patients undergoing ablation compared with no ablation was 0.93 (95% confidence interval, 0.52-1.69; P = .824). Conclusions Atrial fibrillation is present preoperatively in one-fifth of patients with obstructive hypertrophic cardiomyopathy undergoing myectomy and showed a trend toward higher all-cause mortality. Survival of patients undergoing septal myectomy with preoperative atrial fibrillation was similar between those who did and did not receive concomitant surgical ablation.
References25
Newest
#1Bing Tang (Capital Medical University)H-Index: 4
#2Yunhu Song (Peking Union Medical College)H-Index: 12
Last. Shuiyun Wang (Peking Union Medical College)H-Index: 8
view all 7 authors...
OBJECTIVES: This study aims to investigate the risk factors of in-hospital postoperative atrial fibrillation (POAF) and the impact of POAF on the clinical outcome in hypertrophic cardiomyopathy (HCM) patients who underwent myectomy. METHODS: Data from a total of 494 obstructive HCM patients, who had undergone preoperative cardiac magnetic resonance (CMR) testing and who underwent myectomy at Fuwai Hospital from June 2011 to June 2016, were collected. RESULTS: Multivariate logistic regression ana...
7 CitationsSource
#1Griffin Boll (Tufts Medical Center)H-Index: 5
#2Ethan J. Rowin (Tufts Medical Center)H-Index: 26
Last. Martin S. Maron (Tufts Medical Center)H-Index: 70
view all 6 authors...
ABSTRACT Atrial fibrillation (AF) has important clinical consequences in hypertrophic cardiomyopathy (HC). Safety and efficacy of the Cox-Maze IV procedure (when combined with ventricular septal myectomy) in patients with obstructive HC and paroxysmal AF is largely unresolved. Records of 395 consecutive HC patients (age 55 ± 13 years) who underwent septal myectomy for heart failure symptoms between 2004 and 2015 were reviewed. Sixty-two patients also had concomitant complete biatrial Cox-Maze IV...
13 CitationsSource
#1Alexander Iribarne (Dartmouth–Hitchcock Medical Center)H-Index: 12
#2Anthony W. DiScipio (Dartmouth–Hitchcock Medical Center)H-Index: 16
Last. David J. Malenka (Dartmouth–Hitchcock Medical Center)H-Index: 71
view all 14 authors...
Background The Society of Thoracic Surgeons guidelines recommend surgical ablation (SA) at the time of concomitant mitral operations, aortic valve replacement, coronary artery bypass grafting (CABG), and aortic valve replacement plus CABG for patients in atrial fibrillation (AF). The goal of this analysis was to assess the influence of SA on long-term survival. Methods A retrospective analysis of 20,407 consecutive CABG or valve procedures from 2008 to 2015 among seven centers reporting to a pro...
18 CitationsSource
#1Martin S. Maron (Tufts Medical Center)H-Index: 70
#2Paolo SpiritoH-Index: 57
Last. Barry J. Maron (Tufts Medical Center)H-Index: 169
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6 CitationsSource
#1Anita Nguyen (Mayo Clinic)H-Index: 10
#2Hartzell V. Schaff (Mayo Clinic)H-Index: 131
Last. Steve R. Ommen (Mayo Clinic)H-Index: 78
view all 7 authors...
Background In patients with hypertrophic cardiomyopathy (HCM), enlargement of the left atrium (LA) is associated with increased morbidity and mortality because of risk of atrial fibrillation (AF), stroke, and heart failure. In this study, we investigated whether LA reverse remodeling occurs after septal myectomy. Methods Between August 2007 and July 2015, 656 patients underwent myectomy at our institution and had preoperative and postoperative transthoracic echocardiographic (TTE) recording of L...
15 CitationsSource
#1Ethan J. Rowin (Tufts Medical Center)H-Index: 26
#2Anais Hausvater (Tufts Medical Center)H-Index: 2
Last. Barry J. Maron (Tufts Medical Center)H-Index: 169
view all 10 authors...
Background: Atrial fibrillation (AF), the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM), is capable of producing symptoms that impact quality of life and is associated with risk for embolic stroke. However, the influence of AF on clinical course and outcome in HCM remains incompletely resolved. Methods: Records of 1558 consecutive patients followed at the Tufts Medical Center Hypertrophic Cardiomyopathy Institute for 4.8±3.4 years (from 2004 to 2014) were accessed. Result...
100 CitationsSource
Abstract Objective The appearance of atrial fibrillation is associated with significant clinical deterioration in patients with obstructive hypertrophic cardiomyopathy; therefore, maintenance of sinus rhythm is desirable. Guidelines and most articles have reported the results of catheter ablation and pharmacologic atrial fibrillation treatment; nevertheless, data regarding concomitant procedures during septal myectomy are limited. The aim of this study was to assess the outcomes of concomitant a...
20 CitationsSource
#1Elisabetta Lapenna (UniSR: Vita-Salute San Raffaele University)H-Index: 21
#2Alberto Pozzoli (UniSR: Vita-Salute San Raffaele University)H-Index: 18
Last. Ottavio Alfieri (UniSR: Vita-Salute San Raffaele University)H-Index: 93
view all 11 authors...
OBJECTIVES: Atrial fibrillation (AF) is common in patients with hypertrophic cardiomyopathy (HCM) and it is often poorly tolerated because of loss of atrial contraction and reduced filling time with rapid ventricular rates. Restoring sinus rhythm is of great clinical benefit to HCM patients. Very few data exist regarding surgical ablation of concomitant AF in this setting. The aim of this study was to evaluate the mid-term outcome of surgical AF ablation in patients who underwent cardiac surgery...
14 CitationsSource
#1Vinay Badhwar (WVU: West Virginia University)H-Index: 31
#2J. Scott Rankin (WVU: West Virginia University)H-Index: 42
Last. Niv Ad (WVU: West Virginia University)H-Index: 34
view all 15 authors...
Executive Summary Surgical ablation for atrial fibrillation (AF) can be performed without additional risk of operative mortality or major morbidity, and is recommended at the time of concomitant mitral operations to restore sinus rhythm. (Class I, Level A) Surgical ablation for AF can be performed without additional operative risk of mortality or major morbidity, and is recommended at the time of concomitant isolated aortic valve replacement, isolated coronary artery bypass graft surgery, and ao...
221 CitationsSource
#1Joon Hwa Hong (Mayo Clinic)H-Index: 3
#2Hartzell V. Schaff (Mayo Clinic)H-Index: 131
Last. Steve R. Ommen (Mayo Clinic)H-Index: 78
view all 7 authors...
Abstract Background Incidence and outcome of mitral valve (MV) surgery are unknown in patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing extended transaortic septal myectomy. Objectives This study sought to define indications and suitable operative strategy for mitral regurgitation (MR) in patients with HOCM. Methods A total of 2,107 septal myectomy operations performed in adults from January 1993 to May 2014 at Mayo Clinic in Rochester, Minnesota, were retrospectively revie...
91 CitationsSource
Cited By5
Newest
#1Michael Seco (USYD: University of Sydney)H-Index: 12
#2Jonathan Cl Lau (USYD: University of Sydney)
Last. Paul G. Bannon (USYD: University of Sydney)H-Index: 32
view all 4 authors...
Introduction null Atrial fibrillation is common in patients with hypertrophic cardiomyopathy, and significantly impacts mortality and morbidity. In patients with atrial fibrillation undergoing septal myectomy, concomitant surgery for atrial fibrillation may improve outcomes. null Methods null A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All studies reporting the outcomes of combined septal myectomy and atrial fibril...
Source
#1Yanhai Meng (Peking Union Medical College)H-Index: 3
#2Yanbo Zhang (Peking Union Medical College)H-Index: 1
Last. Shuiyun Wang (Peking Union Medical College)H-Index: 8
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Objective: Atrial fibrillation is the most prevalent persistent arrhythmia in patients with hypertrophic obstructive cardiomyopathy. Comparative analyses of the safety and effectiveness of septal myectomy with and without surgical ablation are limited. This study aimed to compare the outcomes of septal myectomy with and without the Cox-maze IV procedure in patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation. Methods: Ninety-four patients with hypertrophic obstructive ca...
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#1Dawn S. Hui (University of Texas Health Science Center at San Antonio)H-Index: 6
#2Richard T. Lee (Georgia Regents University)H-Index: 145
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#1Harold G. RobertsH-Index: 8
#2Lawrence M. WeiH-Index: 10
Last. Vinay Badhwar (WVU: West Virginia University)H-Index: 31
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