Life-long management of atrial fibrillation in a patient with hypertrophic obstructive cardiomyopathy following alcohol septal ablation: A10-year follow-up case report.

Alcohol septal ablation (ASA) is an established septal reduction therapy for patients with drug-refractory hypertrophic obstructive cardiomyopathy (HOCM). However, its impact on the long-term incidence of atrial fibrillation (AF) remains unclear. We report a case of a 68-year-old man with HOCM who underwent successful ASA with an improvement in heart failure (HF) symptoms. Four years later, recurrent AF developed, requiring catheter ablation twice. Subsequently, subarachnoid hemorrhage occurred during anticoagulation therapy. Because of the high thromboembolic and bleeding risks and unsuitable anatomy for percutaneous left atrial appendage (LAA) closure, surgical LAA occlusion was performed. This case highlights the importance of lifelong AF management following successful ASA.