Abstract
BACKGROUND: Pulsed-field ablation (PFA) may be beneficial for the treatment of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM). OBJECTIVES: To compare the safety and efficacy of PFA and thermal ablation in patients with HCM and AF. METHODS: From 2016 to 2024, patients with HCM undergoing a first AF ablation using PFA or Thermal ablation (cryoballoon or radiofrequency) were retrospectively included from 3 French and Swiss centers. Freedom from atrial arrhythmia (AA) recurrence at 12-months follow-up was assessed. RESULTS: Overall, 10 patients (78% male, median age 60 years, 43% paroxysmal AF) with HCM underwent PFA (n=58), or Thermal ablation (n=51) of AF. In addition to pulmonary vein (PV) isolation, extra-PV ablation was performed in 62% of PFA cases and in 18% of Thermal cases. PFA was associated with shorter procedure times than thermal ablation (81 min [interquartile range (IQR) 60—110) vs 132 min [IQR 75—190], p<0.0001), and with less post-procedural heart failure (n=0 vs. n=4, p=0.03). Freedom from AA recurrence was 57% (95% confidence interval [CI] 46—67) after 12 months. PFA was associated with less atrial arrhythmia recurrence than thermal ablation (adjusted hazard-ratio [HR] 0.46, 95% CI 0.23—0.91, P=0.03). Extra-PV ablation was associated with more sustained AA recurrence with thermal ablation (HR 3.07, 95%CI 1.21—7.82, P=0.02), but not with PFA (HR 1.07, 95%CI 0.35—3.27, P=0.91). CONCLUSIONS: In patients with HCM and AF, PFA seems to be associated with better safety and efficacy outcomes than thermal ablation. [Figure: see text]