Catheter ablation in Asian patients with atrial fibrillation and hypertrophic cardiomyopathy: electrophysiological characteristics of recurrence and long-term clinical outcomes

Chih-Hsien Lin; Chin-Yu Lin; Fa-Po Chung; Yenn-Jiang Lin; Shih-Lin Chang; Li-Wei Lo; Yu-Feng Hu; Tze-Fan Chao; Jo-Nan Liao; Ting-Yung Chang; Ta-Chuan Tuan; Ling Kuo; Cheng-I Wu; Chih-Min Liu; Shin-Huei Liu; Guan-Yi Li; Ming-Jen Kuo; Chi-Jen Weng; Shih-Ann Chen

doi:10.3389/fcvm.2023.1135230

Catheter ablation in Asian patients with atrial fibrillation and hypertrophic cardiomyopathy: electrophysiological characteristics of recurrence and long-term clinical outcomes

Front Cardiovasc Med. 2023 May 12:10:1135230. doi: 10.3389/fcvm.2023.1135230. eCollection 2023.

Authors

Chih-Hsien Lin^{1

2}, Chin-Yu Lin^{2

3}, Fa-Po Chung^{2

3}, Yenn-Jiang Lin^{2

3}, Shih-Lin Chang^{2

3}, Li-Wei Lo^{2

3}, Yu-Feng Hu^{2

3}, Tze-Fan Chao^{2

3}, Jo-Nan Liao^{2

3}, Ting-Yung Chang^{2

3}, Ta-Chuan Tuan^{2

3}, Ling Kuo^{2

3}, Cheng-I Wu^{2

3}, Chih-Min Liu^{2

3}, Shin-Huei Liu^{2

3}, Guan-Yi Li², Ming-Jen Kuo², Chi-Jen Weng⁴, Shih-Ann Chen^{2

3

4

5}

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
² Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan.
³ Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁴ Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.
⁵ Vice President Office, National Chung Hsing University, Taichung, Taiwan.

Abstract

Background: Catheter ablation (CA) is a treatment strategy for atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM). We investigated the electrophysiological characteristics of recurrence in a tertiary referral center and compared long-term clinical outcomes after CA therapy with patients who did not undergo CA.

Methods: Patients with HCM and AF who underwent CA (group 1, n = 60) or pharmacological treatment (group 2, n = 298) between 2006 and 2021 were enrolled in this study. The baseline characteristics and electrophysiological characteristics of group 1 patients were examined to elucidate the reason for the recurrence of AF after CA therapy. The clinical results of the patients in Group 1 and Group 2 were compared using a propensity score (PS)-matched method.

Results: The most common cause of recurrence was pulmonary vein reconnection (86.5%), followed by non-pulmonary vein triggers (40.5%), cavotricuspid isthmus flutter (29.7%), and atypical flutter (24.3%). Thyroid disease (HR, 14.713; P < 0.01), diabetes (HR, 3.074; P = 0.03), and non-paroxysmal AF (HR, 4.012; P = 0.01); these factors independently predicted recurrence. After the first recurrence, patients who underwent repeat CA showed a better arrhythmia-free state (74.1%) than those who underwent drug escalation therapy (29.4%, P < 0.01). After matching, PS-group 1 patients showed significantly better outcomes in all-cause mortality, heart failure hospitalization, and left atrial reverse remodeling than PS-group 2 patients.

Conclusions: Patients who underwent CA showed better clinical outcomes than those who underwent drug therapy. The main predictors of recurrence were thyroid disease, diabetes, and non-paroxysmal AF.

Keywords: atrial fibrillation; catheter ablation; hypertrophic cardiomyopathy; long-term outcomes; recurrence.

Grants and funding

This work was funded by the Ministry of Science and Technology of Taiwan (109-2314-B075 -076 -MY3, 111-2314-B-075 -007 -MY3). Chin-Yu Lin is the recipient of the funding award. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.