Treatment of atrial fibrillation in hypertrophic cardiomyopathy/ Hipertrofik kardiyomiyopatide atriyal fibrilasyonun tedavisi

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Authors: Khashayar Hematpour and Jonathan S. Steinberg
Date: Dec. 2006
From: The Anatolian Journal of Cardiology (Anadolu Kardiyoloji Dergisi)(Vol. 6, Issue 4)
Publisher: KARE Publishing
Document Type: Article
Length: 3,474 words

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ABSTRACT

Atrial fibrillation (AF) is present in 5 percent of hypertrophic cardiomyopathy (HCM) patients at the time of diagnosis. Ostial pulmonary vein (PV) diameter is increased in patients with AF as well as hypertensive patients. These findings support the theory that the cascade of events leading to diastolic dysfunction might predispose a person to AF by stretching the PVs. This mechanism is likely relevant to AF in HCM as well. The recognition that AF often times arises from the PVs has led to innovation of ablation techniques that target this zone to electrically isolate the PVs from the left atrium (LA). Anticoagulation is the cornerstone of AF treatment. Additional AF treatment in HCM patients depends on the initial decision regarding need for surgical intervention, whether or not AF is permanent, and the severity of symptoms in patients with non-permanent AF. If surgery is planned, correction of the arrhythmia with MAZE procedure, which isolates the arrhythmogenic foci, at the time of myectomy is an option to consider. The goal in HCM patients with permanent AF is to control the heart rate whether by chronic medications or through ablate + pace procedure. Based on the severity of symptoms, HCM patients with non-permanent AF will be treated with either the rate control strategy ([beta]-blockers/calcium channel blocker) or the rhythm control strategy (PV ablation, antiarrhythmic drugs, or radiofrequency ablation of the LA). This is because adverse effects of antiarrhythmics and complications after invasive procedures are justifiable only in HCM patients who experience severe symptoms. (Anadolu Kardiyol Derg 2006; 6 Suppl 2: 44-8)

Key words: Cardiomyopathy, hypertrophy, atrial fibrillation, pulmonary vein, ablation

OZET

Hipertrofik kardiyomiyopati (HKM)'li hastalarin %5'inde tani konuldugu sirada atriyal fibrilasyon (AF) mevcuttur. Atriyal fibrilasyonu olan hastalarda, hipertansif hastalarda oldugu gibi, ostiyal pulmoner ven (PV) capi buyuktur. Bu bulgular diyastolik disfonksiyona yol acan olay zincirinin PV'lerin gerilmesi araciligi ile bireyleri AF'den etkilenmesine neden olduklari teorisini desteklemektedir. Muhtemelen bu mekanizma HKM'de AF ile de ilgilidir. Atriyal fibrilasyonun PV'lerden kaynaklandiginin taninmasi, PV'lerin sol atriyumdan (LA) elektriksel olarak izole edilmesini hedeseyen ablasyon tekniklerinde yeniliklere yol acmistir.Antikoagulasyon AF tedavisinde bir temeldir. Hipertrofik kardiyomiyopatili hastalarda AF'nin ek tedavileri cerrahi mudahale gereksinimi hakkinda ilk karara ve AF'si surekli olmayan hastalarda semptom siddetine baglidir. Eger cerrahi mudahale planlaniliyor ise dusunulmesi gereken diger opsiyon da, miyektomi sirasinda aritmojenik odaklari izole eden MAZE islemi ile aritminin duzeltilmesidir. Surekli AF'si olan HKM'li hastalarda amac kronik ilac tedavisi veya "ablate+pace" islemi araciligi ile kalp hizinin kontroludur. Surekli olmayan AF ve HKM'si olan hastalar semptom siddetine dayanarak hiz kontrolu stratejisi (beta-bloker/ kalsiyum kanal blokeri) veya ritm kontrolu stratejisi (PV ablasyonu, antiaritmik ilaclar, veya LA radyofrekans ablasyonu) uygulanarak tedavi edilmelidir. Antiaritmik ilaclarin yan etkileri ve invazif islemlerin komplikasyonlari goz onune alinir ise, bu tedavilerin uygulanmasi sadece siddetli semptomlari olan HKM'li hastalarda savunulabilir. (Anadolu Kardiyol Derg 2006; 6 Ozel Sayi 2: 44-8)

Anahtar kelimeler: Kardiyomiyopati, hipertrofi, atriyal fibrilasyon, pulmoner ven, ablasyon

Introduction

Hypertrophic cardiomyopathy (HCM) is transmitted by an autosomal dominant pattern of inheritance and has a prevalence, estimated to be 1 in 500 in the general...

Source Citation

Source Citation
Hematpour, Khashayar, and Jonathan S. Steinberg. "Treatment of atrial fibrillation in hypertrophic cardiomyopathy/ Hipertrofik kardiyomiyopatide atriyal fibrilasyonun tedavisi." The Anatolian Journal of Cardiology [Anadolu Kardiyoloji Dergisi], vol. 6, no. 4, 2006, p. S44+. Accessed 30 Sept. 2020.
  

Gale Document Number: GALE|A157746083