What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertrophic cardiomyopathy and atrial fibrillation (n=257). Intervention: Catheter ablation for atrial fibrillation vs. Medical therapy alone. Primary outcome: Composite of all-cause death, nonfatal myocardial infarction, and ischemic stroke (HR 0.24, 95% CI 0.06-0.95, p=0.042).

What question did this study set out to answer?

To evaluate the long-term association between first-time catheter ablation for atrial fibrillation and major clinical outcomes in patients with hypertrophic cardiomyopathy compared to medical therapy alone.

August 19, 2026Scientific Reports0 citationsOpen Access

Ablation for atrial fibrillation improves clinical outcomes in patients with hypertrophic cardiomyopathy

LDLei DingChinese Academy of Medical Sciences & Peking Union Medical College BZBin ZhouChinese Academy of Medical Sciences & Peking Union Medical College AZAikai ZhangChinese Academy of Medical Sciences & Peking Union Medical College

Key Result

Atrial fibrillation ablation was associated with a significantly lower risk of the primary composite endpoint of all-cause death, nonfatal myocardial infarction, and ischemic stroke compared with medical therapy alone (HR 0.24).

Key Points

To evaluate the long-term association between first-time catheter ablation for atrial fibrillation and major clinical outcomes in patients with hypertrophic cardiomyopathy compared to medical therapy alone.
Retrospective cohort study of 257 patients with hypertrophic cardiomyopathy and atrial fibrillation (142 undergoing first-time ablation vs 115 receiving medical therapy alone).
Assessed primary composite outcome of all-cause death, nonfatal myocardial infarction, and ischemic stroke alongside secondary outcomes over a median follow-up of 1,248 days.
The ablation group showed a significantly lower risk of the primary composite endpoint compared with medical therapy alone (HR 0.24, 95% CI: 0.06–0.95, P = 0.042), despite a 40.8% (58/142) recurrence of atrial tachycardia/AF.
Patients with recurrent AF after ablation maintained a lower risk of the primary endpoint compared to the non-ablation group (HR 0.09, 95% CI: 0.01–0.62, P = 0.015).
AF ablation was associated with a significant reduction in hospitalization for heart failure (HR 0.40, 95% CI: 0.18–0.90, P = 0.027).

Study Design

Type

Cohort (n=257)

Multicenter

Structured PICO

Does first-time AF ablation reduce the composite risk of all-cause death, nonfatal MI, and ischemic stroke in patients with hypertrophic cardiomyopathy and atrial fibrillation compared to medical therapy alone?

Population

257 patients with hypertrophic cardiomyopathy and atrial fibrillation, followed for a median of 1248 days to evaluate the association between AF ablation and clinical outcomes.

Exposure

First-time radiofrequency catheter ablation (RFCA) for AF, consisting of pulmonary vein isolation (PVI) with additional ablations (linear ablation, complex fractionated atrial electrogram ablation, ethanol infusion into Marshall vein, superior vena cava isolation) performed as needed.

Comparator

Medical therapy alone, including rate control (beta-blockers, verapamil, or diltiazem) or rhythm control (cardioversion or antiarrhythmic drugs) and anticoagulation, in accordance with clinical guidelines.

Outcome

Composite of all-cause death, nonfatal myocardial infarction (MI), and ischemic stroke (IS) during the follow-up period.composite

In patients with hypertrophic cardiomyopathy and atrial fibrillation, catheter ablation is associated with a significantly lower risk of major adverse cardiovascular events compared to medical therapy alone, even among those who experience AF recurrence.

Main Result

Hazard Ratio: 0.24 (95% CI 0.06–0.95)

Absolute Event Rate: 5.6% vs 19.7%

p-value: p=0.042

Limitations

Single-center, retrospective, observational study design limits the ability to draw causal conclusions.
Treatment allocation was not randomized, leading to potential selection bias and confounding by indication.
Residual confounding due to unmeasured variables may remain despite multivariable adjustment and propensity score matching.
Follow-up assessments based on 24-hour Holter monitoring and event-driven ECGs may have missed asymptomatic or intermittent arrhythmic episodes.
High proportion of patients undergoing ablation at a specialized center may limit generalizability to other populations.
Relatively low event rates for secondary endpoints limited statistical power.

Abstract

Atrial fibrillation(AF) is the most common sustained arrhythmia in patients with hypertrophic cardiomyopathy(HCM) and is associated with increased mortality, and poorer clinical outcomes. This study aimed to evaluate the long-term association between AF ablation and clinical outcomes in patients with HCM and AF. Patients with HCM and AF were enrolled. Those who underwent first-time AF ablation(ablation group) were compared with those who received medical therapy alone(non-ablation group). The primary endpoint was a composite of all-cause death, nonfatal myocardial infarction, and ischemic stroke. The secondary endpoints including cardiovascular death, nonfatal myocardial infarction/ischemic stroke, and hospitalization for heart failure(HF). A total of 257 patients was included, with 142 in the ablation group and 115 in the non-ablation group. After a median follow-up of 1248 days, atrial tachycardia/AF recurred in 40.8% (58/142) of patients in the ablation group. The ablation group was associated with a lower incidence of the primary endpoint than the non-ablation group (hazard ratioHR 0.24, 95% confidence intervalCI: 0.06–0.95, P = 0.042). Notably, even patients with recurrent AF after ablation also had a lower risk of the primary endpoint than those without ablation (HR 0.09, 95% CI: 0.01–0.62, P = 0.015). AF ablation was also associated with a lower risk of HF hospitalization (HR 0.40; 95% CI: 0.18–0.90, P = 0.027). In this retrospectively cohort of patients with HCM and AF, AF ablation was associated with a reduced risk of major adverse events compared with medical therapy alone. This association was also observed in patients with AF recurrence.

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