AUTHOR=Lin Chih-Hsien , Lin Chin-Yu , Chung Fa-Po , Lin Yenn-Jiang , Chang Shih-Lin , Lo Li-Wei , Hu Yu-Feng , Chao Tze-Fan , Liao Jo-Nan , Chang Ting-Yung , Tuan Ta-Chuan , Kuo Ling , Wu Cheng-I , Liu Chih-Min , Liu Shin-Huei , Li Guan-Yi , Kuo Ming-Jen , Weng Chi-Jen , Chen Shih-Ann TITLE=Catheter ablation in Asian patients with atrial fibrillation and hypertrophic cardiomyopathy: electrophysiological characteristics of recurrence and long-term clinical outcomes JOURNAL=Frontiers in Cardiovascular Medicine VOLUME=10 YEAR=2023 URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1135230 DOI=10.3389/fcvm.2023.1135230 ISSN=2297-055X ABSTRACT=Background

Catheter ablation (CA) is a treatment strategy for atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM). We investigated the electrophysiological characteristics of recurrence in a tertiary referral center and compared long-term clinical outcomes after CA therapy with patients who did not undergo CA.

Methods

Patients with HCM and AF who underwent CA (group 1, n = 60) or pharmacological treatment (group 2, n = 298) between 2006 and 2021 were enrolled in this study. The baseline characteristics and electrophysiological characteristics of group 1 patients were examined to elucidate the reason for the recurrence of AF after CA therapy. The clinical results of the patients in Group 1 and Group 2 were compared using a propensity score (PS)-matched method.

Results

The most common cause of recurrence was pulmonary vein reconnection (86.5%), followed by non-pulmonary vein triggers (40.5%), cavotricuspid isthmus flutter (29.7%), and atypical flutter (24.3%). Thyroid disease (HR, 14.713; P < 0.01), diabetes (HR, 3.074; P = 0.03), and non-paroxysmal AF (HR, 4.012; P = 0.01); these factors independently predicted recurrence. After the first recurrence, patients who underwent repeat CA showed a better arrhythmia-free state (74.1%) than those who underwent drug escalation therapy (29.4%, P < 0.01). After matching, PS-group 1 patients showed significantly better outcomes in all-cause mortality, heart failure hospitalization, and left atrial reverse remodeling than PS-group 2 patients.

Conclusions

Patients who underwent CA showed better clinical outcomes than those who underwent drug therapy. The main predictors of recurrence were thyroid disease, diabetes, and non-paroxysmal AF.