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Catheter ablation in patients with atrial fibrillation and hypertrophic obstructive cardiomyopathy: a real-world

Dharmindra Dulal1, Ahmed Maraey2, Ahmed Younes3

  • 1Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.

European Heart Journal. Quality of Care & Clinical Outcomes
|September 26, 2025
PubMed

Insights

Catheter ablation (CA) significantly reduces all-cause mortality and ischemic stroke risk in patients with hypertrophic obstructive cardiomyopathy (HOCM) and paroxysmal atrial fibrillation (PAF). This procedure also increases cardioversion rates without impacting new-onset heart failure.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiovascular Research

Background:

  • Atrial fibrillation (AF) frequently coexists with hypertrophic obstructive cardiomyopathy (HOCM).
  • This comorbidity increases risks of stroke and mortality.
  • Outcomes of catheter ablation (CA) for AF in HOCM patients are not well-documented.

Purpose of the Study:

  • To assess the long-term impact of catheter ablation (CA) on outcomes in patients with hypertrophic obstructive cardiomyopathy (HOCM) and paroxysmal atrial fibrillation (PAF).
  • Evaluate the association between CA and reduced risks of mortality and stroke in this specific patient population.

Main Methods:

  • Retrospective analysis of adult patients diagnosed with HOCM and PAF between 2015-2021 using the TriNetX Research Network.
  • Patients were divided into CA and non-CA groups, with propensity score matching (1:1) to control for confounding factors.
  • Primary outcomes included 3-year all-cause mortality and ischemic stroke; secondary outcomes were cardioversion and new-onset heart failure.

Main Results:

  • All-cause mortality was significantly lower in the CA group (4.9% vs. 13.7%; HR: 0.35).
  • Ischemic stroke rates were also significantly reduced post-CA (6.4% vs. 9.7%; HR: 0.63), including de novo strokes.
  • Cardioversion rates were higher in the CA group (30.1% vs. 10.1%), with no significant difference in new-onset heart failure.

Conclusions:

  • Catheter ablation is associated with substantially lower risks of all-cause mortality and ischemic stroke in patients with HOCM and PAF.
  • The findings support CA as a beneficial intervention for managing AF in this high-risk cohort.
Abstract

Keywords:
Atrial fibrillationCatheter ablationHypertrophic obstructive cardiomyopathyIschemic strokeMortalityOutcomes

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