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Impact of Ablation on AF Burden and Symptoms in HCM
Quick Takes
- Catheter ablation significantly reduces AF burden in most patients with HCM, as shown by long-term continuous CIED monitoring.
- However, over the long-term, repeat ablations and the use of antiarrhythmic drugs were common but resulted in a sizeable reduction of AF burden for patients with both paroxysmal and persistent AF.
- Additional prospective trials of AF ablation in HCM are indicated, to assess AF burden, symptoms, and quality of life, and may provide additional insight.
Study Questions:
What is the impact of atrial fibrillation (AF) catheter ablation in patients with hypertrophic cardiomyopathy (HCM) on reduction in AF burden and symptoms?
Methods:
The investigators established a multicenter registry to enroll HCM patients with pre-existing cardiac implantable electronic devices (CIEDs) undergoing catheter ablation of AF between 2017 and 2021. The first AF recurrence and burden 12 months before and after catheter ablation were determined. Odds ratios were provided with 95% confidence intervals (CIs) and the level of significance for all tests was set at α < 0.05.
Results:
Eighty-one HCM patients with CIEDs underwent catheter ablation 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–catheter ablation was 27.0% (Q1-Q3 range, 3.0% to 99.0%). Thirty-five (43.2%) patients had AF/atrial tachycardia recurrence within 12 months. AF burden was reduced after catheter ablation 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 Heart 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 Heart Rhythm Association class. AF burden reduction was associated with symptomatic improvement (r = -0.67; p < 0.001).
Conclusions:
The authors report that catheter ablation significantly reduced AF burden and improved symptoms in patients with HCM.
Perspective:
This retrospective study reports that catheter ablation significantly reduces AF burden in most patients with HCM, as shown by long-term continuous CIED monitoring. However, over the long-term, repeat ablations and the use of antiarrhythmic drugs were common but resulted in a sizeable reduction of AF burden (95.0% relative reduction) for patients with both paroxysmal and persistent AF (85.0% and 99.5%, respectively). Patients may have reduced perception of AF following ablation, which may have accounted for some of the symptomatic benefit. Additional prospective trials of AF ablation in HCM are indicated, to assess AF burden, symptoms, and quality of life, and may provide additional insight.
Clinical Topics: Arrhythmias and Clinical EP, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Heart Failure and Cardiomyopathies
Keywords: Atrial Fibrillation, Catheter Ablation, Hypertrophic Cardiomyopathy, Implantable Devices
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