Recurrent atrial fibrillation after ablation with apical HCM

Hello everyone,

I am writing on behalf of my father, and I would be very grateful for any advice or shared experience.

My father is 68 years old and lives in Vietnam. He has a history of **paroxysmal atrial fibrillation**. In **July 2023**, he underwent **radiofrequency ablation with pulmonary vein isolation**. As I understand it, this was a **thermal ablation** procedure. Unfortunately, the experience was very difficult for him. The procedure lasted about **5 hours**, he had **severe pain**, and he **fainted multiple times** during the procedure. Afterward, he was extremely exhausted.

Since then, his rhythm problems appear to have recurred. More recent evaluations suggest that he has:

* **Recurrent atrial fibrillation / recurrent arrhythmia**
* **Apical hypertrophic cardiomyopathy (HCM)**, non-obstructive
* **Complete right bundle branch block**
* **Premature atrial and ventricular beats**
* **One documented episode of non-sustained ventricular tachycardia (NSVT)**

His recent symptoms have become more frequent and more severe. He now has:

* irregular or skipped heartbeats
* chest tightness or chest pain
* palpitations
* shortness of breath, even at rest
* dizziness, fatigue, and near-fainting
* episodes of low blood pressure

We also have Apple Watch ECG recordings showing:

* **Atrial fibrillation** on **December 24, 2025** with heart rates of **110 bpm** and **104 bpm**
* **Bradycardia** on **April 6, 2026** with a heart rate of **37 bpm**
Other recordings showed sinus rhythm, so this seems to be **paroxysmal/recurrent AF** rather than continuous AF.

Another important point is that my father had coronary angiography in **2012** and again in **2023**, and both showed only **mild coronary artery disease / mild atherosclerosis**, without major progression. So at this point, we believe the main problem is more related to **AF + apical HCM + arrhythmia risk**, rather than severe obstructive coronary disease.

Our family is now trying to find the **best hospital in Asia** for him, especially one with strong experience in:

* **recurrent AF after prior ablation**
* **apical HCM**
* **NSVT / ventricular arrhythmia risk assessment**
* advanced catheter ablation strategies
* ideally **less painful / less burdensome technology** than his previous thermal RF ablation

We are especially concerned because he is **not physically strong enough to go through repeated invasive procedures many times**.

We have considered the United States, including Mayo Clinic, but at the moment we are worried that:

1. the flight from Vietnam to the US may be too long and physically stressful for him, and
2. the cost may be very difficult for our family.

So I would sincerely like to ask:

1. Based on this kind of case, **which hospitals in Asia** would you recommend looking into?
2. Has anyone here had experience with treatment for **AF on the background of apical HCM**?
3. If a second procedure is needed, what kind of center should we prioritize?
4. Should we focus more on a hospital that is strongest in **HCM**, strongest in **electrophysiology/AF ablation**, or one that is very strong in **both together**?

Thank you very much for reading. Any advice, recommendation, or shared experience would mean a lot to my family.