Moss Travis J, Zipse Matthew M, Krantz Mori J, Sauer William H, Salcedo Ernesto E, Schuller Joseph L
Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA.
Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO.
Ann Noninvasive Electrocardiol. 2016 Sep;21(5):443-9. doi: 10.1111/anec.12335. Epub 2016 Mar 11.
Patients with hypertrophic cardiomyopathy (HCM) are at a fourfold to sixfold higher risk of developing atrial fibrillation (AF) compared to the general population, though incidence rates among patients undergoing alcohol septal ablation (ASA) are not well characterized. The purpose of this study was to evaluate atrial fibrillation incidence following ASA.
We studied 132 consecutive HCM patients without comorbid AF that underwent 154 ASA procedures. The incidence of AF in follow-up was assessed through chart abstraction including electrocardiography. Survival free of AF was estimated using Kaplan-Meier methodology.
Over a mean follow-up of 3.6 ± 2.7 years (maximum 11.3 years), 10 (7.6%) patients developed new-onset AF. Of those who developed AF, both resting and provoked left ventricular outflow tract (LVOT) gradients had improved significantly (difference -79.78 mm Hg, P ≤ 0.005). Severity of mitral regurgitation improved in 7 (70%) patients. Survival free of AF was estimated to be 99.1%, 93.7%, and 91.7% at 1, 3, and 5 years.
Despite relieving LVOT obstruction and improving mitral regurgitation severity via ASA, new-onset AF remained a common complication of hypertrophic cardiomyopathy.
肥厚型心肌病（HCM）患者发生心房颤动（AF）的风险比普通人群高4至6倍，不过酒精室间隔消融术（ASA）患者的发病率尚无明确特征。本研究旨在评估ASA术后心房颤动的发生率。
我们研究了132例连续的无合并AF的HCM患者，他们接受了154次ASA手术。通过包括心电图在内的病历摘要评估随访期间AF的发生率。使用Kaplan-Meier方法估计无AF生存情况。
平均随访3.6±2.7年（最长11.3年），10例（7.6%）患者出现新发AF。在发生AF的患者中，静息和激发状态下的左心室流出道（LVOT）梯度均有显著改善（差值-79.78 mmHg，P≤0.005）。7例（70%）患者的二尖瓣反流严重程度有所改善。估计1年、3年和5年无AF生存率分别为99.1%、93.7%和91.7%。
尽管通过ASA缓解了LVOT梗阻并改善了二尖瓣反流严重程度，但新发AF仍是肥厚型心肌病的常见并发症。
