Concomitant Hybrid Versus Catheter Ablation for Atrial Fibrillation With Hypertrophic Cardiomyopathy

After informed consent, 66 eligible admissions will be recruited in 2 centers. Eligible participants will be randomly divided (1:1) into either hybrid or catheter ablation arms, looking for a primary outcome of 1-year freedom from atrial arrhythmias.

Inclusion criteria

• Patients' age is ≥18 y
• Clinically diagnosed hypertrophic cardiomyopathy (any left ventricular wall segment thickness ≥15 mm in genetical negative (or unknown genetical status) patients or ≥13mm in genetical positive ones-as measured by any imaging technique (echocardiography, cardiac magnetic resonance imaging or computed tomography)-that is not explained solely by loading conditions)
• Non-obstructed left ventricular outflow obstruction with peak gradients <30mmHg
• Concomitant with persistent atrial fibrillation (7 days<sustained episode lasting<3 years) with drug-refractory symptoms.
• Be able to understand the contents of the trial, and provide written informed consent to participate in this investigation.

Exclusion criteria

• Patients with left atrial size >60 mm (2-dimensional echocardiography, parasternal long-axis view)
• Contraindicated to systemic anticoagulation
• Left ventricular ejection fraction ≤40%
• Concomitant with left atrium or left atrial appendage emboli
• Concomitant with a coronary or valvular disease that indicates intervention
• Ischaemic stroke within 2 months
• Previous ablation history
• Uncontrolled hyper/hypothyroidism
• End-staged kidney failure
• Concomitantly involved in other trials
• Pregnant or breastfeeding, or women of childbearing age not using a reliable contraceptive method
• Concomitant with bacteremia or at an active phase of infection
• Anatomically not suitable for thoracoscopic surgery(history of chest surgery or radiotherapy, etc.)
• Unwilling or unable to comply with all peri-ablation and follow-up requirements