Atrial Arrhythmia Recurrence After Pulmonary Vein Isolation in Hypertrophic Cardiomyopathy: Insights from Repeat Ablations
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background Patients with hypertrophic cardiomyopathy (HCM) are at high risk for atrial fibrillation (AF) and AF recurrence after catheter ablation remains frequent. Data on mechanisms underlying recurrence and on pulmonary vein isolation (PVI) durability in this setting remain scarce. 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 outcomes during follow-up 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 organized AAs in 7 patients (30%). In 5/16 patients with AF as the predominant clinical recurrence, mappable flutters were induced intra-procedurally. PV reconnection was observed in 74% of patients and 35% of all PVs were reconnected. Left atrial flutters were mapped in 48% of patients, including perimitral and roof-dependent circuits. Repeat ablation was performed with PFA in 48% and radiofrequency in 52%; PV re-isolation was performed in 74% of patients and extra-PV lesions in 61%. Median follow-up time was 12 months after redo ablation. Estimated AA-free survival at 3, 6, and 12 months was 82.6%, 69.6%, and 33.5%. 60% of the patients required a third ablation, and 56% remained on antiarrhythmic drugs. Conclusions In HCM patients undergoing repeat ablation, PV reconnection and left atrial flutters are common mechanisms of recurrence. Long-term rhythm control remains suboptimal with a frequent need for multiple procedures.
Source: Research Square
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7204440446