Key result
Catheter ablation shows unclear comparative effectiveness versus AADs for persistent AF in HCM.
Why the study?
It remains unclear whether the advantage of catheter ablation over antiarrhythmic drugs for persistent atrial fibrillation extends to patients with hypertrophic cardiomyopathy and translates into clinical outcomes.
Strategy selection for persistent AF in HCM should await further data; leaves open comparative effectiveness of ablation versus drugs.
Atrial fibrillation (AF) is the most common arrhythmia in patients with hypertrophic cardiomyopathy (HCM), affecting 20-25% of patients, and is associated with an increased risk of heart failure, stroke, and mortality1. Managing AF in HCM is uniquely challenging due to myocardial remodeling, autonomic dysfunction, and inflammatory responses, which predispose these patients to arrhythmias with many progressing to persistent AF (PsAF) which is poorly tolerated1. While catheter ablation (CA) has been shown to be more effective than antiarrhythmic drugs (AAD) for patients with PsAF in maintaining sinus rhythm and significantly reducing AF burden and symptoms, it remains unclear whether this advantage extends to patients with HCM and translates into clinical outcomes2.
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Shahrori et al. (2025) conducted a review in Persistent atrial fibrillation in hypertrophic cardiomyopathy. Catheter ablation vs. Antiarrhythmic drugs was evaluated. The comparative effectiveness of catheter ablation versus antiarrhythmic drugs for persistent atrial fibrillation in patients with hypertrophic cardiomyopathy remains unclear.
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