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.