Efficacy of Catheter Ablation of Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy

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Background: Hypertrophic cardiomyopathy (HCM) tends to demonstrate advanced remodeling of the left atrium, which may cause a poor outcome of ablation for atrial fibrillation (AF). Aim: To assess the efficacy of the catheter ablation of AF in patients with HCM. Methods and Results: This study included 12 patients (9 male, aged 59+7 years) with symptomatic drug-resistant paroxysmal (n=5), persistent (n=6) or long-standing persistent AF (n=1) who underwent extensive pulmonary vein isolation (EPVI). Of the 12 patients, 5 had hypertrophic obstructive cardiomyopathy. The average ejection fraction was 54+13% and average left atrial volume index (LAVI) was 49±12 ml/m2. During a mean follow-up of 483±197 days, 8 patients (67%) had an AF recurrence without any anti-arrhythmic drugs (AADs). Of those patients, three were maintained in sinus rhythm (SR) with AADs, and six underwent a second ablation procedure. After the second ablation procedure, two patients remained in SR without any AADs, and two were maintained in SR with AADs after the second ablation procedure. The final AF-free rate without any AADs was 50% (6/12) and final AF-free rate with AADs was 83% (10/12). Conclusion: AF recurrences after the first EPVI were high in the patients with HCM. A repeat ablation procedure and AADs were often necessary to obtain a favorable outcome.