Heart rhythm · 2026
Atrial fibrillation recurrence and outcomes in patients with hypertrophic cardiomyopathy: Insights from a nationwide real-world cohort.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Aglan Amro, Fath Ayman R, Silver Jonathan S, Harnish Paul, Hook Bruce, Maron Martin S, Rowin Ethan J
Аннотация
BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia in hypertrophic cardiomyopathy (HCM), associated with morbidity and often refractory to rhythm control. Contemporary data evaluating AF recurrence in HCM remain limited.
OBJECTIVE: This study aimed to characterize AF recurrence in HCM vs non-HCM and predictors of recurence.
METHODS: Using the TriNetX Research Network (2015-2025), patients with AF were grouped by the presence or absence of HCM. Within each group, 3 cohorts were defined based on the index event: initial AF diagnosis, first direct-current cardioversion (DCCV), and first catheter ablation. AF recurrence requiring intervention (new antiarrhythmic, DCCV, or ablation) was assessed at 1 year. HCM and non-HCM cohorts were propensity matched 1:1. Multivariable Cox models identified predictors of recurrence in HCM.
RESULTS: Among 2,548,991 patients with new-onset AF, 31,248 (1.2%) had HCM. This included an HCM diagnosis in 4687 of 194,224 patients undergoing DCCV (2.4%) and 3529 of 124,567 undergoing ablation (2.8%). After matching, AF recurrence was higher in HCM than in non-HCM after the initial AF diagnosis (19.6% vs 14.6%; hazard ratio [HR] 1.25; P < .001), DCCV (47% vs 40.8%; HR 1.14; P < .001), and ablation (36.2% vs 29.3%; HR 1.22; P < .001). In HCM, persistent AF and heart failure predicted recurrence, whereas early ablation (<6 months from AF diagnosis) was associated with lower recurrence than delayed ablation (>12 months).
CONCLUSION: AF in patients with HCM was associated with higher recurrence than matched patients without HCM, reflecting a distinct disease phenotype. Earlier ablation was associated with lower recurrence, supporting consideration of earlier AF treatment interventions and is an area in need of additional study.
OBJECTIVE: This study aimed to characterize AF recurrence in HCM vs non-HCM and predictors of recurence.
METHODS: Using the TriNetX Research Network (2015-2025), patients with AF were grouped by the presence or absence of HCM. Within each group, 3 cohorts were defined based on the index event: initial AF diagnosis, first direct-current cardioversion (DCCV), and first catheter ablation. AF recurrence requiring intervention (new antiarrhythmic, DCCV, or ablation) was assessed at 1 year. HCM and non-HCM cohorts were propensity matched 1:1. Multivariable Cox models identified predictors of recurrence in HCM.
RESULTS: Among 2,548,991 patients with new-onset AF, 31,248 (1.2%) had HCM. This included an HCM diagnosis in 4687 of 194,224 patients undergoing DCCV (2.4%) and 3529 of 124,567 undergoing ablation (2.8%). After matching, AF recurrence was higher in HCM than in non-HCM after the initial AF diagnosis (19.6% vs 14.6%; hazard ratio [HR] 1.25; P < .001), DCCV (47% vs 40.8%; HR 1.14; P < .001), and ablation (36.2% vs 29.3%; HR 1.22; P < .001). In HCM, persistent AF and heart failure predicted recurrence, whereas early ablation (<6 months from AF diagnosis) was associated with lower recurrence than delayed ablation (>12 months).
CONCLUSION: AF in patients with HCM was associated with higher recurrence than matched patients without HCM, reflecting a distinct disease phenotype. Earlier ablation was associated with lower recurrence, supporting consideration of earlier AF treatment interventions and is an area in need of additional study.