Cardiovasc Diagn Ther. 2026 Feb 28;16(1):1. doi: 10.21037/cdt-2025-196. Epub 2026 Feb 11.
ABSTRACT
BACKGROUND: Atrial fibrillation (AF) is the most common type of arrhythmia in patients with hypertrophic cardiomyopathy (HCM) and may worsen their prognosis considerably. However, the effectiveness of radiofrequency catheter ablation (RFCA) for this population is unclear due to the unique pathological features of HCM. The aim of this study was to assess the long-term effectiveness of RFCA, identify independent predictors of AF recurrence, and examine their predictive value for AF recurrence in patients with HCM.
METHODS: Retrospective observational study of patients with HCM and AF who underwent their first session of RFCA between January 2013 and January 2020. Initially, 153 patients were screened, among whom 129 had follow-up data. The patients were divided into two groups based on the presence or absence of arrhythmic recurrence after RFCA: a sinus rhythm (SR) group and a recurrence group. Univariate and multivariate Cox regression models were used to identify the independent predictors of AF recurrence. Receiver operating characteristic curve analysis was applied to establish the value of the comorbidities, age, persistent/permanent AF, procedure type, CAAP-AF score (coronary artery disease, age, sex, atrial diameter, type of AF, and prior antiarrhythmic drug failure), AF duration, age, creatinine level, persistent AF, left atrial diameter (LAD), and APPLE score (age >65 years, persistent AF, impaired estimated glomerular filtration rate, LAD, and ejection fraction) in predicting AF recurrence.
RESULTS: Among the 129 patients, 58 were placed in the SR group and 71 in the recurrence group. Independent predictors of AF recurrence identified by multivariate analysis were female sex (P=0.01), a large LAD (P<0.001), and moderate-to-severe mitral regurgitation (MR) (P=0.008). The CAAP-AF score demonstrated high value for predicting AF recurrence (concordance statistic =0.768; 95% CI: 0.685-0.850; P<0.001), with a sensitivity of 84.5% and a specificity of 56.9% for a score ≥5. RFCA significantly reduced AF-related symptoms in patients with HCM. The mean modified European Heart Rhythm Association (mEHRA) symptom classification was improved from 2.9±0.7 at baseline to 1.9±1.0 at follow-up (P<0.001). The SR group also had a better New York Heart Association (NYHA) class at follow-up than at baseline (2.2±0.9 vs. 1.8±0.7, P=0.006) and also had a higher NYHA functional status at follow-up than did the recurrence group (1.8±0.7 vs. 2.3±0.9, P=0.04). The SR group also experienced fewer embolic events and fewer hospitalizations due to heart failure (HF) exacerbation (P<0.001) and lower HCM-related mortality as compared to the recurrence group (5.6% vs. 0%, P=0.01).
CONCLUSIONS: RFCA may be an effective rhythm control strategy for patients with HCM accompanied by AF, with significant improvement in symptoms and mEHRA and NYHA class. The CAAP-AF score is a predictor of AF recurrence. Rhythm control diminishes the risk of sudden cardiac death (SCD), exacerbation of HF, and HCM mortality, especially in high-risk patients, who may otherwise require strict monitoring.
PMID:41815564 | PMC:PMC12973083 | DOI:10.21037/cdt-2025-196