Clinical implications
The fibrotic process possibly plays a crucial role in the development
and maintenance of AF.8,9 Keeping in mind that only
young patients with paroxysmal AF and less dilated atria display better
long-term outcomes,3-5 the presence of LA
cardiomyopathy with respect to the progression of the disease might have
important implications in ablation outcomes. HCM patients undergo
catheter ablation late in the course of their disease (median of 5.9
years after the diagnosis of atrial arrhythmias),3 and
therefore an extensive structural and electrical remodeling including LA
enlargement and fibrosis is possibly present at the time of catheter
ablation. The present findings suggest that patients with obstructive
HCM exhibit LA cardiomyopathy that affects long-term ablation outcomes.
We postulate that catheter ablation should be performed at the early
stages of AF (paroxysmal phase) where the development of LA
cardiomyopathy is less likely.