Impact of Catheter Ablation on AtrialFibrillation Burden and Symptomsin Patients With HypertrophicCardiomyopathy.

Abstract

Atrial fibrillation (AF) is more common in patients with hypertrophic cardiomyopathy (HCM) and is often highly symptomatic. The impact of catheter ablation (CA) may be under-reported when evaluated by long-term freedom from any atrial arrhythmia. This study aims to evaluate whether CA of AF in patients with HCM would significantly reduce AF burden and improve symptoms. A multicenter registry was established to enroll HCM patients with pre-existing cardiac implantable electronic devices undergoing CA of AF between 2017 and 2021. The first AF recurrence and burden 12months before and after CA were determined. Eighty-one HCM patients with cardiac implantable electronic devices underwent CA of AF. Patients were followed-up for a minimum of 1-year (35 [Q1-Q3 range: 23-50] months). AF was paroxysmal in 38 of 81 (46.9%) patients and burden pre-CA was 27.0% (Q1-Q3 range: 3.0% to 99.0%). Thirty-five (43.2%) patients had AF/atrial tachycardia recurrence within 12months. AF burden reduced after CA to 0.5% (Q1-Q3 range: 0.0% to 11.1%) (P=0.001); a 95% CI (range: 13.8% to 100%) relative reduction. European Hearth Rhythm Association class improved by 1.8 ± 1.3 classes (P<0.001). Of those with AF/atrial tachycardia recurrence, the reduction in AF burden was -33.7% (Q1-Q3 range: -88.9% to -13.8%) (P< 0.001) and 20 (57.1%) patients reported symptomatic improvement by≥1 European Hearth Rhythm Association class. AF burden reduction was associated with symptomatic improvement. (r=-0.67; P< 0.001) CONCLUSIONS: AF recurrence is common after CA in HCM patients, but this may under-represent the impact of CAinthis cohort. CA significantly reduced AF burden and improved symptoms. A comprehensive evaluation of AFburden,symptoms, and hard endpoints is needed to determine the utility of CA in this context.