Long-Term Efficacy of Catheter Ablation for Atrial Fibrillation in Different Phenotypes of Hypertrophic Cardiomyopathy

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertrophic cardiomyopathy with atrial fibrillation (n=116). Intervention: Catheter ablation in apical hypertrophic cardiomyopathy (aHCM) vs. Catheter ablation in septal hypertrophic cardiomyopathy (sHCM). Primary outcome: Atrial tachyarrhythmia recurrence (HR 1.94, 95% CI 1.10-3.43, p=0.021).

Q: What does this research mean for the field?

Patients with apical hypertrophic cardiomyopathy have a significantly higher risk of atrial tachyarrhythmia recurrence following single-procedure catheter ablation compared to those with septal hypertrophic cardiomyopathy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Wei Du; Xinguang Chen; Yan Dong; Qiushi Chen; Nishant Yadav; Fengxiang Zhang

doi:10.31083/rcm41914

October 29, 2025Reviews in Cardiovascular MedicineOpen Access

Long-Term Efficacy of Catheter Ablation for Atrial Fibrillation in Different Phenotypes of Hypertrophic Cardiomyopathy

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Key result

Apical HCM linked to ~94% greater atrial tachyarrhythmia recurrence post-ablation vs septal HCM.

HR 1.94
95% CI 1.10-3.43
P=0.021
n=116

Why the study?

Atrial fibrillation catheter ablation success rates vary across different phenotypes of hypertrophic cardiomyopathy, prompting a comparison of long-term outcomes between apical and septal subtypes.

Does the apical subtype of hypertrophic cardiomyopathy (aHCM) predict higher recurrence of atrial tachyarrhythmia after catheter ablation compared to the septal subtype (sHCM)?

Study Design

Type

Cohort (n=116)

Multicenter

No

Structured PICO

Does the apical subtype of hypertrophic cardiomyopathy (aHCM) predict higher recurrence of atrial tachyarrhythmia after catheter ablation compared to the septal subtype (sHCM)?

P

Population

Patients with hypertrophic cardiomyopathy (HCM) who underwent atrial fibrillation catheter ablation (AFCA) between January 2010 and December 2020.

I

Intervention

Atrial fibrillation catheter ablation (AFCA) in patients with the apical hypertrophic cardiomyopathy (aHCM) subtype

C

Comparator

Atrial fibrillation catheter ablation (AFCA) in patients with the septal hypertrophic cardiomyopathy (sHCM) subtype

O

Outcome

Postoperative recurrence of atrial tachyarrhythmia (ATa) after a single ablation

Main Result

Effect estimate: HR 1.94 (95% CI 1.10-3.43)

Absolute Event Rate: 58.3% vs 35%

p-value: p=0.021

In patients with hypertrophic cardiomyopathy undergoing atrial fibrillation ablation, the apical subtype, hypertension, left atrial enlargement ≥45 mm, and lack of antiarrhythmic drug use predict higher recurrence rates.

Limitations

Absence of a systematic assessment of late gadolinium enhancement (LGE) to measure fibrosis
Single-center retrospective design increases the risk of selection bias and residual confounding
Moderate sample size of 116 participants limits the robustness of subgroup analyses
Genetic factors such as MYBPC3 and MYH7 mutations were not systematically assessed
Absence of left atrial strain parameters and reliance on left ventricular end-diastolic dimension measurements
24-hour Holter monitoring may underestimate asymptomatic recurrences or intermittent ATa episodes
Lack of quantitative symptom assessment restricts evaluation of clinical benefits beyond arrhythmia recurrence

Implication

Apical HCM was associated with higher post-ablation recurrence; leaves open whether phenotype-specific strategies warrant prospective testing.

Abstract

Background: Atrial fibrillation catheter ablation (AFCA) success rates vary across different phenotypes of hypertrophic cardiomyopathy (HCM). Therefore, we compared long-term outcomes between apical (aHCM) and septal (sHCM) subtypes of HCM. Methods: This retrospective study analyzed patients with HCM who underwent AFCA at the First Affiliated Hospital of Nanjing Medical University between January 2010 and December 2020. Results: = 0.028) as independent predictors of postoperative recurrence. Conclusions: An aHCM subtype predicts higher ATa recurrence after a single ablation versus sHCM. Hypertension, a left atrial enlargement ≥45 mm, and no AAD use are independent predictors of recurrence. Meanwhile, optimizing blood pressure and AAD therapy may improve outcomes.

Discussion

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Published by Reviews in Cardiovascular Medicine · CC BY

Cite This Study

Du et al. (2025) conducted a cohort in Hypertrophic cardiomyopathy with atrial fibrillation (n=116). Catheter ablation in apical hypertrophic cardiomyopathy (aHCM) vs. Catheter ablation in septal hypertrophic cardiomyopathy (sHCM) was evaluated on Atrial tachyarrhythmia recurrence (HR 1.94, 95% CI 1.10-3.43, p=0.021). Apical hypertrophic cardiomyopathy was associated with a 94% increased risk of atrial tachyarrhythmia recurrence after a single catheter ablation compared to septal hypertrophic cardiomyopathy (HR 1.94).

synapsesocial.com/papers/6a07090de0d1b213ed841fa6 https://doi.org/10.31083/rcm41914