Effectiveness of radiofrequency catheter ablation for atrial fibrillation in patients with hypertrophic cardiomyopathy: long-term outcomes and predictors of recurrence

Background: Atrial fibrillation (AF) is the most common type of arrhythmia in patients with hypertrophic cardiomyopathy (HCM) and may worsen their prognosis considerably. However, the effectiveness of radiofrequency catheter ablation (RFCA) for this population is unclear due to the unique pathological features of HCM. The aim of this study was to assess the long-term effectiveness of RFCA, identify independent predictors of AF recurrence, and examine their predictive value for AF recurrence in patients with HCM. Methods: Retrospective observational study of patients with HCM and AF who underwent their first session of RFCA between January 2013 and January 2020. Initially, 153 patients were screened, among whom 129 had follow-up data. The patients were divided into two groups based on the presence or absence of arrhythmic recurrence after RFCA: a sinus rhythm (SR) group and a recurrence group. Univariate and multivariate Cox regression models were used to identify the independent predictors of AF recurrence. Receiver operating characteristic curve analysis was applied to establish the value of the comorbidities, age, persistent/permanent AF, procedure type, CAAP-AF score (coronary artery disease, age, sex, atrial diameter, type of AF, and prior antiarrhythmic drug failure), AF duration, age, creatinine level, persistent AF, left atrial diameter (LAD), and APPLE score (age >65 years, persistent AF, impaired estimated glomerular filtration rate, LAD, and ejection fraction) in predicting AF recurrence. Results: Among the 129 patients, 58 were placed in the SR group and 71 in the recurrence group. Independent predictors of AF recurrence identified by multivariate analysis were female sex (P=0.01), a large LAD (P