Efficacy And Safety Study Of Percutaneous Transluminal Septal Myocardial Ablation In Patients With Hypertrophic Obstructive Cardiomyopathy And Atrial Fibrillation

Objective:To evaluate the complications and efficacy of the patients with hypertrophic obstructive cardiomyopathy(HOCM)and atrial fibrillation who after treated with percutaneous transluminal septal myocardial ablation(PTSMA).Furthermore,to Summarize effectiveness and safety of the patients with HOCM and atrial fibrillation who after treated with PTSMA.Methods:283 consecutive patients with HOCM at Liaoning provincial people's hospital who underwent PTSMA between 1999 and 2019 were studied.According to whether or not atrial fibrillation is combined,these 283 patients were divided into two groups,A-HOCM group and N-HOCM group.Clinical data,PTSMA results,occurrence and efficacy of recent complications in the two groups were compared.Then follow up these patients in both groups,and to discuss effectiveness and safety of the patients with HOCM and atrial fibrillation who after treated with PTSMA.Results:1.PTSMA results:LVOTG at rest and after premature beat of the patients in A-HOCM group decreased significantly after the surgery compared with before{[12(4.00,20.00)vs72(29.00,104.50)]mm Hg,[39(27.50,47.50)vs109(85.00,130.00)]mm Hg,P<0.05}.Left ventricular outflow tract diameter increased significantly compared with that before the surgery{[15(11,16)vs10(7,11)]mm,P<0.05}.The differences were statistically significant.LVOTG at rest and after premature beat of the patients in N-HOCM group decreased significantly after the surgery compared with before[(21.81±16.61 vs 68.26±35.53)mm Hg,(37.67±21.91 vs119.13±38.15)mm Hg,P<0.05].Left ventricular outflow tract diameter increased significantly compared with that before the surgery[15(11,18)vs9(7,11)mm,P<0.05].The differences were also statistically significant.2.Comparison of effectiveness of PTSMA results:The change values of LVOTG at rest and after premature beat{[?60(25.00,89.50)]mm Hg vs[?44(23.75,63.00)]mm Hg,P=0.051;?(70.18±50.83)mm Hg vs?(81.11±42.25)mm Hg,P=0.180}and Left ventricular outflow tract diameter{[?4.6(0,7)]mm vs[?4.5(2,9)]mm,P=0.125} before and after surgery were no significant difference between the two groups.Percentage of LVOTG at rest reduction in both groups are over50%[77(57,100)%vs71(53,85)%,P=0.095].Percentage of LVOTG after premature beat in both groups are over 30% [(47±43)% vs(58±25)%,P=0.216].This suggests that PTSMA is effective in both groups,and these differences were not statistically significant(P>0.05).3.Short-term follow-up results:The incidence of short-term postoperative complications was higher in group A-HOCM than in group N-HOCM[17.8%(8/45)vs9.7%(23/238),P>0.05],it had no statistically significant difference.4.Long-term follow-up results:The all-cause mortality[13.3%(6/45)vs2.1%(5/238),P<0.05] and the incidence of long-term postoperative complications[22.2%(10/45)vs9.7%(23/238),P<0.05] of the A-HOCM group were significantly higher than those of the N-HOCM group.And these differences were statistically significant.Conclusions:1.With or without atrial fibrillation,PTSMA is effective for the HOCM patients.2.The HOCM patients with atrial fibrillation had a higher mortality than those without atrial fibrillation.Besides,PTSMA may cause more serious complications.Need to be careful with it.Active treatments of atrial fibrillation are important for patients with HOCM.