Follow-up outcomes of atrial fibrillation ablation in patients with hypertrophic cardiomyopathy: a single-center analysis

Atrial fibrillation (AF) is frequently observed in patients with hypertrophic cardiomyopathy (HCM). Atrial contraction plays a crucial role in preventing symptoms associated with diastolic dysfunction in HCM. However, the outcomes of catheter ablation in this patient population are not well-documented.

This study aims to assess the follow-up results of AF ablation in individuals with HCM.

This retrospective study involved 47 patients with hypertrophic cardiomyopathy (HCM) who underwent AF ablation using either cryoballoon (CB) or radiofrequency (RF) techniques from 2014 to 2023 at the Hacettepe University Department of Cardiology Electrophysiology Unit. Follow-up results were recorded using the hospital’s local medical recording software.

The cohort had a mean age of 54.5 ± 12.4 years, with 53.2% (n=25) of participants being male. The most common comorbidity was hypertension, which was present in 38.3% of the patients. Persistent atrial fibrillation (PeAF) was observed in 31.9% of the patients. Prior septal reduction therapy was performed surgically in 8.5% and percutaneously in 14.9% of patients, while 19.1% had obstructive hypertrophic cardiomyopathy (HCM). The median values of the CHA₂DS₂-VA and HAS-BLED scores were 1 (range 0-4) and 1 (range 0-2), respectively.

RF ablation was performed in 27 patients (57.4%). Successful pulmonary vein isolation (PVI) was achieved in all patients, and additional ablation lines were created in 19 patients (40.4%). During follow-up, five patients (10.6%) died, with two deaths due to non-cardiac causes and three due to heart failure decompensation. The median follow-up duration was 25.8 months (range 1–128 months). Atrial fibrillation (AF) recurrence was observed in 24 patients (51.1%). Multiple procedures were required for 12 patients to maintain sinus rhythm. Atrioventricular (AV) node ablation and pacing were performed in 6 patients (12.8%) during follow-up. Following multiple ablation procedures, during a median follow-up duration of 45.5 months (range 1.4–128.4 months), 7 patients (14.9%) experienced recurrence. The complications were minimal, with pericardial effusion and transient phrenic nerve palsy (PNP) occurring in 2.1% of cases each.

Atrial fibrillation ablation in patients with hypertrophic cardiomyopathy (HCM) demonstrated satisfactory procedural outcomes, with improved long-term AF-free survival in those undergoing multiple ablations. These findings suggest that multiple procedures may enhance rhythm control in this high-risk population while maintaining a relatively low complication rate.

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