Clinical significance of new‐onset atrial fibrillation in patients with hypertrophic cardiomyopathy

Abstract

Aims There is limited information about the clinical significance of atrial fibrillation (AF), particularly new‐onset AF, in patients with hypertrophic cardiomyopathy (HCM) in a community‐based patient cohort. This study was carried out to clarify the prevalence and prognostic impact of AF in Japanese HCM patients. Methods and results In 2004, we established a cardiomyopathy registration network in Kochi Prefecture as a prospective study, and finally, 293 patients with HCM were followed. In the patients' cohort, we recently reported the clinical outcomes including mortality and HCM‐related morbid events. HCM‐related adverse cardiovascular events were defined in the following: (i) sudden cardiac death (SCD)‐relevant events including SCD, spontaneous sustained ventricular tachycardia, and appropriate implantable cardioverter defibrillator discharge; (ii) heart failure (HF) events with the composite of HF death and hospitalization for HF; and (iii) embolic events included embolic stroke‐related death and admission for embolic events. In the present study, we focused on AF and conducted a detailed investigation. At registration, the mean age of the patients was 63 ± 14 years, and 86 patients (29%) had documented AF including paroxysmal AF. Patients with AF at registration were characterized by worse clinical profiles including more advanced age, more symptomatic, more advanced left ventricular, and left atrial remodelling at registration. During a mean follow‐up period of 6.1 ± 3.2 years, a total of 77 HCM‐related adverse events occurred, and the presence of AF at registration was associated with an increased risk of HCM‐related adverse events, particularly heart failure events. During the follow‐up period, an additional 31 patients (11%) had documentation of AF for the first time, defined as new‐onset AF, with an annual incidence of approximately 1.8%, and finally, a total of 117 patients (40%) showed AF. The presence of palpitation and enlarged left atrial diameter, particularly left atrial diameter ≥50 mm, at registration were significant predictors of new‐onset AF. Importantly, the incidence of overall HCM‐related adverse events was further higher in patients with new‐onset AF observed from AF onset than in patients with AF at registration. Conclusions In our HCM registry in an aged Japanese community, a significant proportion developed AF. The presence of AF, particularly new‐onset AF, was associated with increased incidence of HCM‐related events. AF may not be just a marker of disease stage but an important trigger of adverse events.

2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

“…1 Data on AF in patients with HCM published since the 2020 hypertrophic cardiomyopathy guideline were reviewed but did not result in any substantive changes in the recommendations from 2020. 2–6 AF is highly prevalent in HCM and increases the risk of stroke. The CHA 2 DS 2 -VASc score should not apply to patients with HCM, because they have roughly an equivalent risk to a CHADs-VASc of 3.…”

Predictive Factors for Decreasing Left Ventricular Ejection Fraction and Progression to the Dilated Phase of Hypertrophic Cardiomyopathy

“…The current study demonstrated that LVDs and AF (paroxysmal, persistent, or chronic) before enrollment were significant predictors of DHCM. Many studies [4,[16][17][18][19][20] have reported the importance of AF in patients with HCM. AF increases the risk of heart failure, stroke, and sudden death [4,17,20].…”

Comparison Between Heart Failure Without Left Ventricular Systolic Dysfunction and Progression to End-Stage in Hypertrophic Cardiomyopathy

“…LV end-diastolic dimension (mm) 44 [40][41][42][43][44][45][46][47][48] LV end-systolic dimension (mm) 27 [23][24][25][26][27][28][29][30] LVEF (%) 60.5±4.5…”

“…Other abbreviations as in Table1.development of LVSD) simultaneously in a single cohort. Several previous studies have reported predictors of HF hospitalization in HCM; however, no study has focused on LVEF at hospitalization, or other studies considered HF hospitalization as a part of a composite endpoint [23][24][25][26][27][28][29][30]. Some studies have reported progression of NYHA func-predictors and a small overlap, as well as different risk factors from SCD.…”