Cryoballoon Ablation of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy: From the Korean Cryoballoon Ablation Registry

Background and Objectives: Atrial fibrillation (AF) occurs in more than 20% of hypertrophic cardiomyopathy (HCM) patients, further increasing the risk of stroke. Although radiofrequency catheter ablation in AF patients with HCM has been performed, data on cryoballoon ablation (CBA) in HCM patients are limited. We evaluated the efficacy and safety of CBA in HCM patients with AF. Methods: The study included 2,649 patients with AF from the Korean CBA registry database with follow-up >12 months after de novo CBA. The primary efficacy outcome was recurrence of atrial tachyarrhythmias (ATs) ≥30s after a 3-month blanking period. Results: Totals of 1,176 paroxysmal AF (44.4%) and 1,473 persistent atrial fibrillation (PeAF, 55.6%) patients (mean age 61.7 years; 76.7% men) underwent de novo CBA. Compared to non-HCM patients (n=2,590), those with HCM (n=59) had larger left atrium and higher prevalence of heart failure, previous stroke or transient ischemic attack, and PeAF. Procedure-related complications were not statistically different between the 2 groups. During a mean follow-up period of 638±308 days, 875 (33.0%) patients experienced recurrence of ATs (845 [32.6%] non-HCM patients and 30 [50.8%] HCM patients) (p=0.01). The overall AT-free survival rate at 2 years was 45.9% in HCM group and 63.3% in non-HCM group, respectively (p=0.014), whereas there was no significant difference between the two groups in PeAF. Conclusions: CBA may be an effective rhythm control treatment for patients with AF and HCM, with an AT-free survival rate of approximately 50% at 2-year follow-up and low procedure-related complications.