Introduction
Hypertrophic cardiomyopathy (HCM) is the most frequent monogenic
cardiovascular disease and affects 1 out of every 500 individuals
[1]. Atrial fibrillation (AF) is a common feature of HCM, with an
estimated prevalence of 22.5% [1]. Given the high thromboembolic
risk in HCM patients with concomitant AF, life-long oral anticoagulation
is recommended, regardless of the
CHA2DS2VASc score [2-3].
Non-vitamin K anticoagulants (NOACs) have emerged as a valid and more
practical alternative to vitamin K antagonists (VKAs) [4]. Even
though data supporting the use of NOACs in patients with HCM and AF are
sparse, recent observational studies suggest that NOACs might be safely
used in this population [5].
Catheter ablation is an established treatment for AF and is also used in
subjects with HCM [1]. Peri and post-operatively patients are
exposed to an increased risk of thromboembolism [6]. Complications
can occur in up to a fifth of HCM patients undergoing AF ablation
[7]. Although observational studies suggest that ablation can be
safely performed in HCM patients on VKA [1], the safety and efficacy
of such a procedure while on NOACs has not yet been established. The aim
of this study was to address this knowledge gap.