Pulsed-Field vs Thermal Catheter Ablation of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy.

Background: Pulsed-field ablation (PFA) may be beneficial for the treatment of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM).

Objective: The goal of this study was 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 the 12-month follow-up was assessed.

Results: Overall, 109 patients (median age 60 years; 68% male; 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 median procedure times than thermal ablation (81 minutes [Q1-Q3: 60-110 minutes] vs 132 minutes [Q1-Q3: 75-190 minutes]; P < 0.0001) and with less postprocedural heart failure (n = 0 vs n = 4; P = 0.03). Freedom from AA recurrence was 57% (95% CI: 46%-67%) after 12 months. PFA was associated with less AA recurrence than thermal ablation (adjusted 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.