State-of-the-Art Treatments for Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy

Abstract

Atrial fibrillation (AF) and hypertrophic cardiomyopathy (HCM) are two very common clinical entities, which often occur simultaneously, giving a hard time to both patients and cardiologists. Myocyte hypertrophy, myocyte disarray and interstitial fibrosis in the left atrium (LA) predisposes to atrial arrhythmias due to modifications of the substrate that promote re-entry. AF is usually poorly tolerated due to the shortening of the diastolic time with rapid heart rates and the lack of the atrial contribution to the diastolic filling in patients who often have a previous diastolic dysfunction. AF onset frequently results in exercise intolerance and recurrent heart failure admissions and also has prognostic implications. Early maintenance of sinus rhythm appears as a worthy approach in these patients, especially when started early in the course of the disease. However, treatment with antiarrhythmic (AA) agents in HCM patients is less effective than in patients without the disease, and concerns regarding safety frequently limit the long-term adherence. Catheter ablation has limited efficacy in patients with persistent AF but can play an important role in patients with paroxysmal AF, emphasizing the importance of an accurate patient selection. The aim of this review is to provide an overview of the pathophysiology of combined HCM and AF and the principal pharmacological and non-pharmacological treatments recommended in this complex clinical scenario.

Clinical and pathophysiologic determinants of catheter ablation outcome in hypertrophic cardiomyopathy with atrial fibrillation

“…Previous studies reported that AFCA is still effective choice for maintaining sinus rhythm in HCM patients although AFCA is not as efficacious in HCM patients compared to AF patients with no structural heart disease 14,29 . In this study, we investigate repeat procedural findings in AF‐HCM and control groups, and the results revealed that the PV reconnection rate and the existence of extra‐PV triggers during the repeat procedure did not differ between two groups.…”

“…Previous studies reported that AFCA is still effective choice for maintaining sinus rhythm in HCM patients although AFCA is not as efficacious in HCM patients compared to AF patients with no structural heart disease. 14,29 In this study, we investigate repeat procedural findings in AF-HCM and control groups, and the results revealed that the PV reconnection rate and the existence of extra-PV triggers during the repeat procedure did not differ between two groups. These findings might suggest that LV diastolic function may have played a more significant role in the hemodynamics and reverse remodeling of the LA and may have affected AF recurrence rate after de novo AFCA in AF patients with HCM.…”

Comparison of Nonclassic and Classic Phenotype of Hypertrophic Cardiomyopathy Focused on Prognostic Cardiac Magnetic Resonance Parameters: A Single-Center Observational Study

“…In the asymptomatic population of the Multi-Ethnic Study of Atherosclerosis (MESA study), the CMR-assessed elevated LA volumes and decreased LA emptying fractions were independently associated with incident atrial fibrillation (AF) [49]. AF is the most frequent arrhythmia in patients with HCM, and its prevalence ranges between 20% and 30% [50]. It is an important determinant of clinical deterioration due to heart failure or embolic stroke.…”