Key result
HCM links to ~58% higher unadjusted atrial tachyarrhythmia recurrence after cryoballoon ablation but lacks independent risk.
Why the study?
AF occurs in over 20% of HCM patients, increasing stroke risk, but data on cryoballoon ablation in this population remain limited.
Does de novo cryoballoon ablation prevent recurrence of atrial tachyarrhythmias in patients with AF and HCM compared to non-HCM patients?
Cohort (n=2,649)
Yes
Does de novo cryoballoon ablation prevent recurrence of atrial tachyarrhythmias in patients with AF and HCM compared to non-HCM patients?
Hazard Ratio: 1.58 (95% CI 1.1–2.27)
Absolute Event Rate: 50.8% vs 32.6%
p-value: p=0.014
Cryoballoon ablation is a feasible rhythm control strategy for AF in patients with HCM, though they experience a higher recurrence rate compared to non-HCM patients.
Cryoballoon ablation yields lower AT-free survival in HCM versus non-HCM AF; leaves open optimal first-line strategy pending randomized trials.
BACKGROUND AND OBJECTIVES: Atrial fibrillation (AF) occurs in more than 20% of hypertrophic cardiomyopathy (HCM) patients, further increasing the risk of stroke. Although radiofrequency catheter ablation in AF patients with HCM has been performed, data on cryoballoon ablation (CBA) in HCM patients are limited. We evaluated the efficacy and safety of CBA in HCM patients with AF. METHODS: The study included 2,649 patients with AF from the Korean CBA registry database with follow-up >12 months after de novo CBA. The primary efficacy outcome was recurrence of atrial tachyarrhythmias (ATs) ≥30s after a 3-month blanking period. RESULTS: Totals of 1,176 paroxysmal AF (44.4%) and 1,473 persistent atrial fibrillation (PeAF, 55.6%) patients (mean age 61.7 years; 76.7% men) underwent de novo CBA. Compared to non-HCM patients (n=2,590), those with HCM (n=59) had larger left atrium and higher prevalence of heart failure, previous stroke or transient ischemic attack, and PeAF. Procedure-related complications were not statistically different between the 2 groups. During a mean follow-up period of 638±308 days, 875 (33.0%) patients experienced recurrence of ATs (845 [32.6%] non-HCM patients and 30 [50.8%] HCM patients) (p=0.01). The overall AT-free survival rate at 2 years was 45.9% in HCM group and 63.3% in non-HCM group, respectively (p=0.014), whereas there was no significant difference between the two groups in PeAF. CONCLUSIONS: CBA may be an effective rhythm control treatment for patients with AF and HCM, with an AT-free survival rate of approximately 50% at 2-year follow-up and low procedure-related complications.
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Kim et al. (2025) conducted a cohort in Atrial fibrillation (n=2,649). Hypertrophic cardiomyopathy vs. Non-hypertrophic cardiomyopathy was evaluated on Recurrence of atrial tachyarrhythmias ≥30s after a 3-month blanking period (HR 1.58, 95% CI 1.10-2.27, p=0.014). In patients undergoing cryoballoon ablation for atrial fibrillation, hypertrophic cardiomyopathy was associated with a higher unadjusted rate of atrial tachyarrhythmia recurrence compared to non-HCM patients (50.8% vs 32.6%, HR 1.58), though it was not an independent risk factor after adjustment.
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