Clinical Outcomes of Catheter Ablation for Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy.

BACKGROUND

Atrial fibrillation (AF) is common in patients with hypertrophic cardiomyopathy (HCM) and is associated with increased morbidity, heart failure (HF) exacerbations, and adverse long-term outcomes. Although catheter ablation is an established rhythm-control strategy, data comparing its long-term clinical outcomes with anti-arrhythmic drug (AAD) therapy in patients with HCM remain limited.

OBJECTIVE

To compare long-term clinical outcomes of catheter ablation versus medical therapy with AADs in patients with HCM and AF.

METHODS

We conducted a retrospective cohort study using the TriNetX Research Network, a global federated database of electronic health records. Adult patients with HCM and AF between January 2010 and December 2020 were identified and stratified according to treatment with catheter ablation or AAD therapy. Outcomes included all-cause mortality, HF exacerbations, AAD-related adverse events, all-cause hospitalization, ischemic stroke, repeat ablation, need for cardioversion, need for long-term AAD use, and atrioventricular nodal ablation. A 1:1 propensity score matching (PSM) analysis was performed to balance baseline characteristics. Kaplan-Meier survival analysis and Cox proportional hazards models were used to estimate hazard ratios (HRs).

RESULTS

After PSM, 3144 patients were included (1572 in each cohort) with a mean follow-up of approximately 3.4 years. Catheter ablation was associated with lower all-cause mortality compared with AAD therapy (9.5% vs. 14.8%; HR: 0.60; 95% CI: 0.49-0.74; p < 0.001). Ablation was also associated with reduced risk of HF exacerbations (38.4% vs. 43.3%; HR: 0.79; 95% CI: 0.71-0.88; p < 0.001) and fewer AAD-related adverse events (8.4% vs. 11.2%; HR: 0.71; 95% CI: 0.55-0.93; p = 0.011). Rates of all-cause hospitalization (HR: 0.93; p = 0.11) and ischemic stroke (HR: 0.78; p = 0.10) were similar between groups.

CONCLUSION

In this large real-world cohort of patients with HCM and AF, catheter ablation was associated with lower mortality, reduced HF hospitalizations, and decreased AAD therapy-related adverse events, as compared with medical therapy. These findings suggest that catheter ablation may provide meaningful clinical benefits in selected patients with HCM and AF, although prospective studies are needed to confirm these observations.