Background: The prognostic impact of catheter ablation (CA) of atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) patients has not yet been satisfactorily elucidated. Objectives: The aim of the study was to assess the impact of CA of AF on clinical outcomes in a large cohort of HCM patients. Methods: In this retrospective multicenter study, 555 HCM patients with AF were enrolled, 140 undergoing CA and 415 receiving medical therapy. 1:1 propensity score matching led to the inclusion of 226 patients (113 medical group, 113 intervention group) in the final analysis. The primary outcome was a composite of all-cause mortality, heart transplant and acute heart failure exacerbations. Secondary outcomes included AF recurrence and transition to permanent AF. Additionally, an inverse probability weighted (IPW) model was examined. Results: At propensity score matching analysis, after a median follow-up of 58.1 months, the primary end point occurred in 29 (25.7%) patients in intervention group vs 42 (37.2%) in medical group (P = 0.9). Thromboembolic strokes and major arrhythmic events in intervention vs medical group were 9.7% vs 7.1% (P = 0.144) and 4.4 vs 8.0% (P = 0.779), respectively. Fewer patients in intervention vs medical group experienced AF recurrences (63.7% vs 84.1%, P = 0.001) and transition to permanent AF pattern (20.4% vs 33.6%, P = 0.026). IPW analysis showed consistent results. Severe complications related to CA were uncommon (0.7%). Conclusions: After 5 years of follow-up, CA did not improve major adverse cardiac outcomes in a large cohort of patients with HCM and AF. Nevertheless, CA seems to facilitate the maintenance of sinus rhythm and slow the progression to permanent AF, without significant safety concerns

Transcatheter Ablation of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy / Pierri, Alessandro; Albani, Stefano; Merlo, Marco; Buongiorno, Antonia Luisa; Ricotti, Andrea; Grilli, Giulia; Barbisan, Davide; Grossi, Stefano; De Rosa, Catia; Mabritto, Barbara; Luceri, Stefania; Bongioanni, Sergio; Negri, Francesco; Burelli, Massimo; Millesimo, Michele; Biondi, Federico; Cireddu, Manuela; Berg, Jan; Musumeci, Maria Beatrice; Di Donna, Paolo; Vianello, Pier Filippo; Del Franco, Annamaria; Scaglione, Marco; Barbati, Giulia; Urru, Sara; Berchialla, Paola; De Ferrari, Gaetano Maria; Russo, Vincenzo; Agricola, Eustachio; Imazio, Massimo; Porto, Italo; Canepa, Marco; Peretto, Giovanni; Francia, Pietro; Castagno, Davide; Autore, Camillo; Olivotto, Iacopo; Gaita, Fiorenzo; Sinagra, Gianfranco; Musumeci, Giuseppe. - In: JACC. ADVANCES. - ISSN 2772-963X. - 3:5(2024). [10.1016/j.jacadv.2024.100899]

Transcatheter Ablation of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy

Russo, Vincenzo;Agricola, Eustachio;Peretto, Giovanni;
2024-01-01

Abstract

Background: The prognostic impact of catheter ablation (CA) of atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) patients has not yet been satisfactorily elucidated. Objectives: The aim of the study was to assess the impact of CA of AF on clinical outcomes in a large cohort of HCM patients. Methods: In this retrospective multicenter study, 555 HCM patients with AF were enrolled, 140 undergoing CA and 415 receiving medical therapy. 1:1 propensity score matching led to the inclusion of 226 patients (113 medical group, 113 intervention group) in the final analysis. The primary outcome was a composite of all-cause mortality, heart transplant and acute heart failure exacerbations. Secondary outcomes included AF recurrence and transition to permanent AF. Additionally, an inverse probability weighted (IPW) model was examined. Results: At propensity score matching analysis, after a median follow-up of 58.1 months, the primary end point occurred in 29 (25.7%) patients in intervention group vs 42 (37.2%) in medical group (P = 0.9). Thromboembolic strokes and major arrhythmic events in intervention vs medical group were 9.7% vs 7.1% (P = 0.144) and 4.4 vs 8.0% (P = 0.779), respectively. Fewer patients in intervention vs medical group experienced AF recurrences (63.7% vs 84.1%, P = 0.001) and transition to permanent AF pattern (20.4% vs 33.6%, P = 0.026). IPW analysis showed consistent results. Severe complications related to CA were uncommon (0.7%). Conclusions: After 5 years of follow-up, CA did not improve major adverse cardiac outcomes in a large cohort of patients with HCM and AF. Nevertheless, CA seems to facilitate the maintenance of sinus rhythm and slow the progression to permanent AF, without significant safety concerns
2024
atrial fibrillation; catheter ablation; hypertrophic cardiomyopathy; propensity score matching
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11768/159666
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