The impact of the catheter ablation on long-term prognosis in patients with hypertrophic cardiomyopathy and atrial fibrillation

Abstract Background Hypertrophic cardiomyopathy (HCM) is the most common heritable cardiomyopathy and the atrial fibrillation (AF) is the most prevalent tachycardia in patients with HCM. Catheter ablation has been the first-line therapy in AF, however, the impact of catheter ablation on long-term prognosis in patients with HCM and AF remains unclear. Purpose The aim of this study was to evaluate the long-term impact of catheter ablation on prognosis in patients with HCM and AF. Methods The present study included patients diagnosed of HCM and AF at our institution between January 2010 and August 2024. Patients who had a history of maze procedure, surgical myectomy, alcohol septal ablation, catheter ablation of AF, and lost of follow-up were excluded. Patients who underwent first-time AF ablation were assigned to the ablation group, and the remaining patients who received only medical therapy, were assigned to the non-ablation group. Patients in the ablation group were further classified into ablation recurrence and ablation non-recurrence group. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), and the secondary endpoint included all-cause mortality, cardiac death, and heart failure hospitalization. Long-term cumulated risk curves used Kaplan-Meier methods. Multivariate Cox regression was used to identify predictors of poor prognosis. Results A total of 261 patients (61.5 ± 11.6 years, 58.6% male) with HCM and AF were enrolled. Of these, 144 patients were assigned to the ablation group, and the remaining 117 patients were assigned to the non-ablation group. After a median follow-up of 43.8 months, the cumulative incidence of primary endpoint was significantly lower in the ablation group compared to the non-ablation group (log-rank P value = 0.004, Figure 1). All secondary endpoints showed the benefits of AF ablation (all P values < 0.05, Figure 1). Additionally, comparing the with non-ablation group, the ablation recurrence group still had significantly lower cumulative incidence of primary endpoint (log-rank P value = 0.011, Figure 2). There were no significances regarding secondary endpoints (Figure 2). History of diabetes (hazard ratio [HR] 2.08, P = 0.035), stroke (HR 2.94, P = 0.002), and non-ablation of AF (HR 2.48, P = 0.047) could independently predict MACCE. Conclusion Among patients coexisting HCM and AF, patients with AF ablation was associated with a significant lower risk of the MACCE than those without AF ablation. Even AF recurred after ablation, the strategy of AF ablation still have benefit in MACCE outcomes.