Atrial arrhythmia recurrence in hypertrophic cardiomyopathy: insights from repeat ablation
C Pavone, S Gribissa, T Kueffer, S Knecht, X Waintraub, N Badenco, P Charron, R King, E Gandjbakhch, G Duthoit, C Sticherling, T Reichlin, M LaredoAbstract
Background
Patients with hypertrophic cardiomyopathy (HCM) are at high risk for atrial fibrillation (AF). In a previous multicenter study, pulsed field ablation (PFA) demonstrated superior ablation, though arrhythmia recurrence remained frequent. The mechanisms underlying recurrence and the durability of pulmonary vein isolation (PVI) in this setting remain poorly understood.
Methods
This retrospective multicenter study included HCM patients with atrial arrhythmia (AA) recurrence after an initial AF ablation, who underwent repeat ablation with left atrial 3D electroanatomic mapping (EAM). Procedural data, arrhythmia mechanisms, and follow-up outcomes were analyzed.
Results
Among 23 patients (mean age 59±12 years, 26% female), the type of arrhythmia at recurrence was AF in 16 patients (70%) and AFL/AT in 7 patients (30%). PV reconnection was observed in 73%. Atypical left atrial flutters were mapped in 48%, including perimitral and roof-dependent circuits. AF was the predominant clinical recurrence (70%), but 31% of these patients also had mappable flutters intra-procedurally. Repeat ablation was performed with PFA in 47% and radiofrequency in 52%. Procedural success was high, with no major complications. During a median follow-up of 12 months, 78% experienced AA recurrence; 60% required a third ablation and 52% remained on antiarrhythmic drugs. Estimated AA-free survival at 3, 6, and 12 months was 82.6%, 69.6%, and 33.5%, respectively.
Conclusions
In HCM patients undergoing repeat ablation, PV reconnection and atypical flutters are common mechanisms of recurrence. Despite the use of advanced ablation strategies, long-term rhythm control remains suboptimal with a need for several procedures in case of a failed initial ablation.Figure 1