Clinical significance of atrial fibrillation in hypertrophic cardiomyopathy

Abstract

Atrial fibrillation (AF) is the most common sustained arrhythmia in patients with hypertrophic cardiomyopathy (HCM), and it bears numerous pathophysiologic consequences that potentially affect patient outcome and symptoms. However, studies regarding the impact of AF on the long-term prognosis of HCM patients have been limited in number, with sometimes conflicting results. Recently, studies on community-based patient populations showed that AF is associated with long-term clinical deterioration, embolic complications, and increased cardiovascular mortality due to heart failure and stroke. The consequences of AF on the long-term prognosis of HCM patients are not uniformly unfavorable, however, and in about one third of patients the arrhythmia is compatible with an uneventful course.

High Incidence of De Novo and Subclinical Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy and Cardiac Rhythm Management Device

“…The overall prevalence of AF in our cohort was higher compared to other HCM cohorts. Nearly 1 out of 3 patients had AF, whereas in other HCM cohorts AF was identified in 22–24% of HCM patients …”

“…In our study, including 44 patients with HCM who were treated with a CRM device, we have seen some interesting results: The incidence of de novo AF in patients with HCM after implantation of a CRM device was rather high with 53%. The majority of these patients with de novo AF (88%) were asymptomatic at the time of detection. The overall prevalence of AF in our cohort was higher compared to other HCM cohorts. Nearly 1 out of 3 patients had AF, whereas in other HCM cohorts AF was identified in 22–24% of HCM patients AF was the main reason for inappropriate ICD therapy in HCM patients. …”

Hypertrophic cardiomyopathy as a cause of sudden death

“…The ultimate (and most reliable) meth- [58] • LV gradient > 30 mmHg at rest [59,60] • Late enhancement in MRI [49,50] od for diagnostic accuracy is the demonstration of regression of left ventricular hypertrophy after 3 months of detraining. This is characteristic of physiological hypertrophy but will not be observed in HCM [46].…”

Sports and Exercise in Athletes with Hypertrophic Cardiomyopathy

“…12 Treatment options for HCM include ICDs to prevent SCD, as well as medications, percutaneous alcohol septal ablation, or surgical myectomy to reduce symptomatic outflow tract obstruction. Rate-or rhythm-control strategies, including radiofrequency ablation along with anticoagulation, are used in the management of AF.…”