Atrial fibrillation in hypertrophie cardiomyopathy: A longitudinal study

Abstract

The clinical outcome of 52 consecutive patients with hypertrophic cardiomyopathy who developed paroxysmal (less than 1 week) or established (greater than or equal to 1 week) atrial fibrillation between 1960 and 1985 was examined retrospectively and compared with that of a matched group of patients with hypertrophic cardiomyopathy and sinus rhythm. Follow-up study until death or the present ranged from 6 months to 24 years (median 11 years) from diagnosis and from 6 months to 22 years (median 7 years) from the onset of atrial fibrillation. Atrial fibrillation was present in 6 patients at the time of diagnosis, whereas it developed subsequently in 46. The acute onset of arrhythmia was associated with a change in symptoms in 41 (89%) of the 46. After initial treatment of acute atrial fibrillation, sinus rhythm was restored in 29 (63%) of the 46 patients; 43 (93%) of the 46 returned to their original symptom class. Stepwise logistic regression revealed that shorter duration of arrhythmia and amiodarone therapy were the most powerful predictors of return to sinus rhythm. Sinus rhythm was maintained during a median follow-up period of 5.5 years in 22 of the 29 patients in whom it was restored after initial therapy. During follow-up study, 25 of the 52 patients were treated with conventional therapy alone and 7 with amiodarone alone. Amiodarone therapy was associated with maintenance of sinus rhythm, fewer alterations in drug therapy, fewer embolic episodes and fewer attempted direct current cardioversions (during a shorter follow-up period).(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Impact of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy Results From Kochi RYOMA Study

“…The impact of AF on major morbidity with cardioembolic events and HF admission was again highlighted, as in the previous limited number of existing studies on AF in HCM populations. [12][13][14][15][16][17] …”

Detection of patients with hypertrophic cardiomyopathy at risk for paroxysmal atrial fibrillation during sinus rhythm by P‐wave dispersion

“…1,2 Atrial fibrillation (AF) episodes are associated with systemic thromboembolism and poor prognosis in patients with HCM. 3 A prolonged intra-and interatrial electrical conduction time, an increased fragmentation of the intra-atrial electrocardiogram (ECG), and an increased dispersion of atrial refractoriness are well-known electrophysiologic characteristics predisposing to AF [4][5][6] and are reflected in P-wave morphology and duration on the 12-lead ECG. 7 Heterogeneity of structural properties of the atrial myocardium in HCM predisposes to generation of unidirectional block of premature impulses, thus causing atrial reentry.…”

Contraction‐excitation feedback in human atrial fibrillation

“…Furthermore, the findings of this study might explain the common occurrence of AF in conditions such as left ventricular hypertrophy with an otherwise normal heart in which the atrial size may reflect the degree of left ventricular dysfunction?" 22 …”