BACKGROUND To date, the prognostic impact of transcatheter ablation (T-Abl) of supraventricular arrhythmias (SA) in HCM patients has not been satisfactorily elucidated.
OBJECTIVES To assess the impact of T-Abl on clinical outcomes in a large cohort of HCM patients.
METHODS In this retrospective multicenter study, 570 consecutive HCM patients with SA were enrolled, 425 receiving medical therapy and 145 undergoing T-Abl. 1:1 propensity score matching (PSM) led to the inclusion of 234 patients (117 intervention group, 117 medical group) in the final analysis for endpoint evaluation. The primary outcome was a composite of all-cause mortality, heart transplantation (HT) and worsening heart failure (HF). Additionally, an inverse probability weighted (IPW) model was elaborated.
RESULTS At PSM analysis, after a median follow‐up of 57.3 months, the primary endpoint occurred in 31 (26.5%) patients in the intervention group vs 38 (32.5%) in the medical group (p=0.871). Thromboembolic strokes and major arrhythmic events in the intervention vs the medical group were 9.4% vs 9.4% (p=0.367) and 5.1 vs 7.7% (p=0.741), respectively. Fewer patients in the intervention vs medical group experienced SA recurrences (64.1% vs 84.6%, p<0.001) and transition to permanent SA patterns (21.4% vs 37.6%, p=0.007). IPW analysis showed consistent results. Severe complications related to T-Abl were uncommon (0.7%).
CONCLUSIONS At 5-year follow-up, T-Abl does not improve major clinical outcomes in a large cohort of HCM patients. Nevertheless, T-Abl seems to facilitate the maintenance of sinus rhythm and decelerate the progression to permanent SA. Lastly, T-Abl is usually safe in HCM.