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