Pulsed-field ablation for atrial fibrillation treatment in patients with hypertrophic cardiomyopathy: efficacy and outcomes

Abstract Background Pulsed-field ablation (PFA) is an emerging non-thermal ablation technique for the treatment of atrial fibrillation (AF). 25% of patients with hypertrophic cardiomyopathy (HCM) have an history of AF. In patients with HCM, conventional catheter ablation using thermal energy sources, such as radiofrequency (RF) or cryothermal ablation, have shown reduced efficacy in achieving freedom from recurrent atrial arrhythmias. This study aims to assess the outcomes of PFA in comparison to traditional thermal ablation methods in patients with HCM. Methods A retrospective analysis was conducted on patients with HCM and symptomatic AF who underwent pulmonary vein isolation (PVI) between 2019 and 2024. A total of 42 consecutive patients were included, 20 treated using a pentaspline PFA-catheter and 22 with thermal ablation catheters, including radiofrequency, cryo and laser balloon. Follow-up data were successfully obtained for 38 patients. The primary endpoint was freedom from any atrial tachyarrhythmias recurrence. Results The median age of the cohort was 62 years, persistent AF was present in 45% of patients. No significant baseline difference was found between the two groups. PFA-guided PVI was successfully achieved in all patients, with a mean procedural time of 32 minutes for the PFA group, compared to 71 minutes in the thermal ablation group (P < 0.0001). Fluoroscopy time was comparable between groups (8.5 minutes for PFA vs. 8.3 minutes for thermal ablation, P=0.852). No serious acute adverse events occurred. Freedom from atrial tachyarrhythmias at one year was observed in 88% of patients treated with PFA, versus 57% in the thermal ablation group (log-rank P=0.086). Conclusions In patients with HCM undergoing PVI for AF, PFA demonstrated a favorable trend toward a lower recurrence rate of atrial tachyarrhythmias at one-year follow-up compared to thermal ablation strategies. These findings suggest that PFA may offer a promising alternative to thermal energy sources in this patient population.Kaplan-Meier survival analysis