Imaging and mapping of arrhythmias in hypertrophic cardiomyopathy

The most common sustained arrhythmia in hypertrophic cardiomyopathy, atrial fibrillation generally produces symptoms that impact quality of life and is associated with risk for embolic stroke. When antiarrhythmic agents fail to maintain normal sinus rhythm in symptomatic patients, catheter ablation is generally the next treatment option. With advances in mapping and ablation techniques, clinical outcomes with ablation have shown continued improvement. Catheter ablation has been used successfully in large series of patients with monomorphic ventricular tachycardia that occurs in the setting of ischemic, non-ischemic, congenital, and valvular heart disease. However, there is considerably less clinical data with imaging, mapping, and catheter ablation of ventricular arrhythmias in HCM. When antiarrhythmic therapy is not successful in treating AF, ablation using radiofrequency energy or cryoablation is a safe and generally successful approach. Less commonly, surgical treatment with a maze procedure is needed for pharmacologically refractory AF that has not responded to catheter ablation.