Ablation of Atrial Fibrillation in the Setting of Hypertrophic Cardiomyopathy

摘要

Electrophysiologists, particularly those hopeful about the eventual promise of ablation, tend to believe that atrial fibrillation (AF) is primarily an electrical disease. This is natural, given the usual demographic that we treat younger patients with modest structural heart disease. Victory is seemingly certain if we only can treat the patient early enough to prevent electrical remodeling, relegating progressive fibrosis and even atrial enlargement to a minor supporting role.AF occurring in the setting of hypertrophic cardiomyopathy (HCM) is a break from this way of thinking. AF is common in HCM, has severe hemodynamic consequences, and exaggerates the risk of related stroke. Given the substantial and progressive structural remodeling in this disease process, can the electrical "cure" offered by ablation ever be a successful long-term strategy?