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Left atrial substrate characterization in patients with atrial fibrillation and hypertrophic cardiomyopathy: evidence for an extensive fibrotic disease
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  • Michael Efremidis,
  • George Bazoukis,
  • Konstantinos Vlachos,
  • Efstathia Prappa,
  • Aris Anastasakis,
  • Athanasia Megarisiotou,
  • Stelios Dragasis,
  • Dimitrios Asvestas,
  • Panagiotis Mililis,
  • Athanasios Saplaouras,
  • Theodoros Efremidis,
  • Athena Batsouli,
  • Natalia Zimpounoumi,
  • Kosmas Valkanas,
  • Antonios Sideris,
  • Konstantinos Letsas
Michael Efremidis
Evangelismos General Hospital of Athens
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George Bazoukis
Evangelismos General Hospital Cardiology Clinic
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Konstantinos Vlachos
Evangelismos General Hospital of Athens
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Efstathia Prappa
Evangelismos Athens General Hospital
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Aris Anastasakis
Onassis Cardiac Surgery Center Department of Cardiology
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Athanasia Megarisiotou
Evangelismos Athens General Hospital Department of Cardiology
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Stelios Dragasis
Evangelismos Athens General Hospital Department of Cardiology
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Dimitrios Asvestas
Mitera General Hospital Department of Adult Cardiology
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Panagiotis Mililis
Evangelismos Athens General Hospital Department of Cardiology
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Athanasios Saplaouras
Evangelismos Athens General Hospital
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Theodoros Efremidis
Evaggelismos Hospital
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Athena Batsouli
Evaggelismos Hospital
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Natalia Zimpounoumi
Evaggelismos Hospital
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Kosmas Valkanas
Evangelismos Athens General Hospital
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Antonios Sideris
Evangelismos Athens General Hospital
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Konstantinos Letsas
Evangelismos Athens General Hospital Cardiology Cinic
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Abstract

Introduction. Data regarding the left atrial (LA) electroanatomical substrate in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF) are missing. In this electroanatomical mapping (EAM) study, we evaluated the extent of LA fibrosis and its impact on catheter ablation outcomes in patients with HCM and AF. Methods. High-density LA EAM was performed during AF in 28 consecutive patients with obstructive HCM and AF (42.9% displayed paroxysmal AF and 57.1% persistent AF). After propensity matching (PS), 28 non-HCM patients with AF were selected, and served as controls. Two different cut-off values of bipolar signal amplitude were investigated for fibrosis characterization (≤0.25 mV and ≤0.4 mV). HCM patients underwent pulmonary vein antral isolation (PVAI) and roof line, while non-HCM patients PVAI only. Results. After the 3-month blanking period, 10 HCM patients (35.7%) displayed atrial arrhythmia recurrence. Univariate analysis revealed that the extent of LA fibrosis was the only predictor of AF recurrence. HCM patients with arrhythmia recurrence showed significantly greater low voltage areas defined as either bipolar voltage ≤0.25 mV (22.5±10% vs. 5.5±6.4%, p=0.001) or ≤0.4 mV (32±13.9% vs. 5.9±5.1%, p<0.001). The presence of low voltage areas ≤0.4 mV greater than 14.1% of the total LA area also predicted arrhythmia recurrence with excellent sensitivity (100%) and specificity (100%). After PS matching with non-HCM patients, patients with HCM exhibited wider fibrotic regions ≤0.25 mV compared to non-HCM patients (p=0.016). Conclusions. High-density EAM reveals extensive LA fibrotic disease in patients with HCM, an event with certain implications in catheter ablation outcomes.

Peer review status:Published

Jun 2021Published in Journal of Electrocardiology. 10.1016/j.jelectrocard.2021.06.001