Utilization and Complications of Catheter Ablation for Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy - The 67th Annual Conference of the Israel Heart Society

Guy Rozen ¹ Gabby Elbaz-Greener ² Ibrahim Marai ¹ Nizar Andria ¹ Seyed Mohammadreza Hosseini ⁴ Yitschak Biton ² Edwin Kevin Heist ³ Jeremy Neil Ruskin ³ Yulia Gavrilov ⁵ Shemy Carasso ¹ Diab Ghanim ¹ Offer Amir ²

¹Cardiovascular Institute, Padeh Medical Center, Poriya, Israel
²Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
³Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, USA
⁴Department of Medicine, Yale School of Medicine, New Haven, USA
⁵Biostatistics Department, TechnoSTAT Ltd., Raanana, Israel

Background. The reported safety for Atrial Fibrillation (AF) ablation, in patients with hypertrophic cardiomyopathy (HCM), is inconsistent. We aimed to investigate the utilization of catheter ablation for AF and analyze real-world incidence and predictors of peri-procedural complications in patients with HCM.

Methods. We drew data from the National Inpatient Sample (NIS), using the ICD-9-CM codes to identify cases of ablation for AF in patients with HCM between 2003-2015 in the U.S. Socio-demographic and clinical data, including AF ablation complications as well as mortality and length of stay were analyze, and compared between the early (2003-2008)and later (2009-2015) study years.

Results. Weighted total of 1563 AF ablation hospitalizations were analyzed. The median age was 62(IR: 52-72), 832(53.2%) of the patients were male and 1150(73.6%) were white. At least one complication occurred in 16.1% of cases and in-hospital mortality rate was 1%. Despite increased prevalence of co-morbidities such as obesity, diabetes mellitus and renal failure, there was a significant decline in complication rate from 20.9% to 14.0% in the later study years. The most common complication was hemorrhage (6.9%), followed by cardiac complications (4.3%). Cardiac and pericardial complications declined from 8.8% to 2.3% and from 2.8% to 0.9%, respectively, between the early and the later study years (p<0.01). Independent predictors of complications included: female gender (OR 4.81, 95%CI 2.72-8.51), diabetes mellitus (OR 6.57, 95%CI 2.68-16.09) and obesity (OR 3.82, 95%CI 1.61-9.06).

Conclusion. Despite some decline in procedural complications over the years, catheter ablation for AF is still associated with a relatively high peri-procedural morbidity and mortality in HCM patients. The concerns over procedural safety in these patients along with the low efficacy based on prior studies, emphasize the importance of careful clinical consideration in referring patients with HCM for an AF ablation.