ISSN 2996-8215
International Journal of Cardiology | Vol. 17, No. 5, May 2026 | pp. 33–40
DOI: 10.46882/2026/IJC/000205
Original Research Article
Three-Year Longitudinal Stability Matrix Post-Pulmonary Linear Ablation within Substrate Remodeled Hydrotrophic Cavities
Alessandro Mancini¹, Roberto Romano¹, Giovanni Esposito²
¹Department of Cardiovascular Sciences, University of Naples Federico II, Naples, Italy
²Division of Electrophysiology, San Raffaele Hospital, Milan, Italy
Abstract:
Atrial fibrillation (AF) is the most frequent sustained arrhythmia in patients with hypertrophic cardiomyopathy (HCM), poorly tolerated due to diastolic dysfunction, and associated with heart failure acceleration and stroke. Catheter ablation is an effective rhythm control strategy in general cohorts, but its long-term durability in structurally remodeled HCM hearts remains unclear. This study evaluated the 3-year efficacy and safety of catheter ablation for paroxysmal or persistent AF in patients with HCM. We prospectively followed 85 consecutive HCM patients who underwent radiofrequency catheter ablation (pulmonary vein isolation with or without additional linear/substrate ablation). The primary endpoint was freedom from recurrent atrial tachyarrhythmias lasting longer than 30 seconds after a 90-day blanking period. At 3-year follow-up, overall freedom from recurrent AF was achieved in 51.8% of patients after a single procedure, increasing to 68.2% after a secondary procedure (repeat intervention required in 22.4% of patients). Success rates were significantly higher in patients with paroxysmal AF than in those with persistent AF (64.5% vs. 37.0%, p = 0.01). Left atrial diameter greater than or equal to 48 mm was identified as an independent predictor of arrhythmia recurrence (hazard ratio: 1.85, 95% CI: 1.12–3.04, p = 0.02). Periprocedural major complications included 2 cases of femoral pseudoaneurysm and 1 case of transient ischemic attack, with no procedurally related deaths. Catheter ablation is safe and moderately effective for long-term rhythm control in HCM patients, achieving higher success rates when performed early during the paroxysmal phase.
Keywords: Hypertrophic cardiomyopathy, Atrial fibrillation, Catheter ablation, Pulmonary vein isolation, Recurrence, Remodeling
Received: February 12, 2026; Revised: March 25, 2026; Accepted: April 10, 2026; Published: May 20, 2026