Kassar Ahmad, Chamoun Nadia, Haykal Romanos, Chahine Yaacoub, Al Yasiri Hala, Hensley Tori, Owens David, Akoum Nazem
Division of Cardiology, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA.
Department of Medicine, University of Washington, Seattle, WA, USA.
J Interv Card Electrophysiol. 2025 Mar 8. doi: 10.1007/s10840-025-02027-6.
Cardiomyopathy (CM) is associated with atrial remodeling and atrial fibrillation (AF), often complicating rhythm management. Ventricular dysfunction contributes to AF through pressure and volume overload, while AF worsens ventricular function via tachycardia and irregular activation. Evidence suggests catheter ablation improves outcomes in CM patients, though success is influenced by the extent of atrial and ventricular remodeling.
Patients undergoing their first catheter ablation for AF were divided into hypertrophic (HCM), ischemic (ICM), non-ischemic (NICM), and no-CM groups. Pre-ablation late-gadolinium enhancement cardiac magnetic imaging (LGE-MRI) was used to assess left atrial (LA) fibrosis burden and anatomical distribution. Patients were followed prospectively for arrhythmia recurrence.
A total of 552 patients, 39 HCM (69% obstructive), 39 ICM, 115 with NICM, and 359 without CM were included between January 2015 and December 2022. LA fibrosis was significantly higher in patients with CM (19.1 ± 7.5% vs. 16.5 ± 6.9%; P = 0.01). HCM and ICM had the greatest LA fibrosis among the different CM subtypes (21.3 ± 8.7% and 21.9 ± 9.1%, respectively). There was no significant difference in the regional distribution of fibrosis among the various groups. AF recurrence was observed in 321 (58.2%) after 456 (175-1204) days. Multivariate analysis revealed that compared to no CM, HCM was associated with a three-fold increase in AF recurrence (HR = 3.07, 95% CI 2.06-4.58, P < 0.001), followed by ICM (HR 1.61, 95%, CI 0.95-2.72; P = 0.07) and NICM (HR of 1.53, 95% CI 1.14-2.06; P = 0.05). LA fibrosis and volume index were independently associated with recurrence (HR = 1.03, 95% CI 1.01-1.06, P = 0.01 and HR = 1.02, 95% CI 1.01-1.03, P = 0.01). Genetic testing revealed key distinctions between HCM and NICM, with MYBPC3 and MYH7 as prominent genes in HCM and a heterogeneous genetic basis in NICM.
Hypertrophic cardiomyopathy is associated with the highest risk of AF recurrence followed by ischemic and non-ischemic cardiomyopathy after catheter ablation. LA fibrosis regional patterns did not differ between cardiomyopathy types, while overall fibrosis and volume predicted recurrence.
心肌病（CM）与心房重构和心房颤动（AF）相关，常使节律管理复杂化。心室功能障碍通过压力和容量超负荷导致房颤，而房颤则通过心动过速和不规则激活使心室功能恶化。有证据表明，导管消融可改善CM患者的预后，尽管成功率受心房和心室重构程度的影响。
首次接受AF导管消融的患者分为肥厚型（HCM）、缺血型（ICM）、非缺血型（NICM）和无CM组。消融前采用延迟钆增强心脏磁共振成像（LGE-MRI）评估左心房（LA）纤维化负担和解剖分布。对患者进行前瞻性心律失常复发随访。
2015年1月至2022年12月共纳入552例患者，其中39例HCM（69%为梗阻性）、39例ICM、115例NICM和359例无CM患者。CM患者的LA纤维化明显更高（19.1±7.5%对16.5±6.9%；P=0.01）。在不同的CM亚型中，HCM和ICM的LA纤维化程度最高（分别为21.3±8.7%和21.9±9.1%）。各组之间纤维化的区域分布无显著差异。456（175-1204）天后，321例（58.2%）出现AF复发。多变量分析显示，与无CM相比，HCM与AF复发风险增加三倍相关（HR=3.07，9
