PO-02-158 PACE AND ABLATE IS AN EFFECTIVE MANAGEMENT STRATEGY FOR ATRIAL FIBRILLATION IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY

Abstract

Atrial fibrillation (AF) is common in patients with hypertrophic cardiomyopathy (HCM). In this cohort, the sequel of rapid ventricular response and symptoms associated with an irregular rhythm can be challenging to manage with medical therapy and catheter ablation (CA). Pace and ablate (PAb) strategy may offer an effective treatment alternative. Assess the efficacy of PAb in patients with HCM who have failed medical therapy and/or catheter ablation for AF. Single centre study with retrospective analysis of a prospectively collated HCM registry. PAb patients were identified. Baseline characteristics, procedural indication and procedural data was collected and symptoms defined by NYHA and EHRA classification plus echocardiographic findings in follow-up assessed. Forty-two patients (17 (40%) male and age 67±11 years) were included (Table 1) of which 18 (43%) patients had undergone previous CA ablation. Indications for PAb: 5 (12%) inappropriate shock, 24 (57%) ineffective rate control and 13 (31%) to regularise rhythm to improve symptoms. Procedural parameters: procedure time 70±12mins and immediate success in 40 patients (95%) with no complications. During a follow-up time of 62±54 months, left ventricular ejection fraction (LVEF) post PAb remained stable (LVEF Pre 52±10%, LVEF Post 50±9%, p=0.6). Those without a CRT also had no change in LV function during follow-up post PAb (LVEF pre 55±8% vs post 51±19%, p=0.21). Thirty-three (83%) patients reported an improvement in symptoms post procedure. In patients with symptom improvement there was no difference in AF type (14/15, 93% paroxysmal vs. 19/25, 76% persistent AF; p=0.22), presence of at least moderate mitral regurgitation (MR) (12/33, 36% moderate MR. 1/7, 14% no moderate MR; p=0.39), LV impairment (10/11, 91% LVEF <50% vs. 23/29, 79% LVEF ≥50%; p=0.65) or CRT device in situ (22/24, 92% CRT vs. 11/16, 69% no CRT; p=0.09). Symptoms improved in 10 (76%) patients who underwent PAb to regularise rhythm. In the majority of patient with HCM and AF, PAb improves symptoms without impacting LV function regardless of AF type, device implanted or the presence of pre-existing LV impairment. PAb was also shown to effectively improve symptoms through regularising the rhythm. Post PAb, LV function remains stable regardless of the type of device implanted. PAb is an effective treatment strategy for AF in patients with HCM.