AB-452666-3 CATHETER ABLATION IN ASIAN PATIENTS WITH ATRIAL FIBRILLATION AND HYPERTROPHIC CARDIOMYOPATHY: ELECTROPHYSIOLOGICAL CHARACTERISTICS OF RECURRENCE AND LONG-TERM CLINICAL OUTCOMES

Abstract

Catheter ablation (CA) is an effective and safe strategy for treating atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM). We investigated the electrophysiological characteristics of recurrence at a tertiary referral center and compared the long-term clinical outcomes after CA therapy with patients who did not receive CA. Patients with HCM and AF who underwent CA (group 1, n=60) or pharmacological treatment (group 2, n=298) from 2006 to 2021 were enrolled. The patients’ baseline characteristics and electrophysiological features were examined to elucidate the reason for AF recurrence after CA in part I of the study (group 1). The clinical outcomes of group 1 and group 2 patients were compared using a propensity score (PS)-matched method in part II. In part I, the most common cause of recurrence was pulmonary vein (PV) reconnection (86.5%), followed by non-PV triggers (40.5%), cavotricuspid isthmus flutter (29.7%), and atypical flutter (24.3%). Thyroid disease (HR: 14.713, p<0.001), diabetes (HR: 3.074, p=0.034), and non-paroxysmal AF (HR: 4.012, p=0.007) independently predicted recurrence. After the first recurrence, the patients who underwent repeat CA demonstrated better arrhythmia-free status (74.1%) compared to those who underwent drug-escalation therapy (29.4%, p=0.004). In part II, after matching, PS-group 1 patients had significantly better outcomes in all-cause mortality, heart failure hospitalization, and left atrium reverse remodeling than PS-group 2 patients. Patients who underwent CA had better clinical outcomes than those who did not receive CA. The main recurrence predictors were thyroid disease, diabetes, and non-paroxysmal AF.