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. 2020 Oct 31;13(3):2337.
doi: 10.4022/jafib.2337. eCollection 2020 Oct-Nov.

Prevalence and Impact of Atrial Fibrillation in a Cohort of Patients with Hypertrophic Cardiomyopathy in Ireland

McClelland S  1 , O'Connor Sa  2 , Donohue S  1 , Lavelle L  1 , McErlean A  3 , Dodd Jd  1 , Meaney J  2 , McCreery Cj  1 , McDonald K  1 , Quinn M  1 , Erwin Je  1 , Quigley Pj  1 , Maurer B  4 , Keane D  1
Affiliations

Prevalence and Impact of Atrial Fibrillation in a Cohort of Patients with Hypertrophic Cardiomyopathy in Ireland

McClelland S et al. J Atr Fibrillation. .

Abstract

Aims: Atrial fibrillation (AF) is the most common sustained arrhythmia in patients with hypertrophic cardiomyopathy (HCM), and is associated with deterioration in clinical status and outcome. To date, no data have been published pertaining to AF in an Irish HCM population.

Methods and results: 159 patients with HCM attending St Vincent's University Hospital and Blackrock Clinic, Dublin, were identified. Detailed review of medical notes, Holter monitor, echocardiogram, cardiac MRI (CMR) and implantable cardioverter-defibrillator (ICD) records was performed.Prevalence of AF was 38.4%. HCM patients with AF (HCM-AF) were older (60.6±14.8 v 54.9±17.3 years, P=0.016) and more symptomatic (NYHA II: 29.7% v 16.9%, NYHA III: 4.3% v 1.2%) than HCM patients without AF. History of stroke was recorded in 16.4% of HCM-AF patients, compared with 1% in those without AF.HCM-AF patients had lower left ventricular ejection fraction (echo: 59.5±11.8v68±8, P<0.001; CMR: 62.3%v70.5%, P<0.01) and higher left atrial diameter (echo: 49.8±9.5v40.9±7.4, p<0.001; CMR 62.3±11.3v70.4±9, p<0.001), compared with those without AF. Myocardial fibrosis was detected on CMR in 74% of HCM-AF patients and 62% of those without AF.34% of patients had an ICD in situ, of whom 61% had AF. 24% of these HCM-AF patients received inappropriate shocks, all triggered by AF.

Conclusion: AF is common in the Irish HCM population. It is associated with increased risk of stroke, deterioration in symptom status and is a common trigger for inappropriate ICD discharge. We have shown, in-keeping with previous studies, that AF is associated with reduced EF, increased LA diameter and mitral regurgitation in this HCM population.

Keywords: Atrial fibrillation; Cardiac MRI; Hypertrophic Cardiomyopathy; Left Atrium.

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Figures

Figure 1.
Figure 1.. Symptom status in HCM patients with and without atrial fibrillation:
33.4% of HCM-AF patients were in NYHA functional class II or III, compared with 18.1% of Non-AF HCM patients. Data are expressed as percentage (%) of HCM population in each symptom class.
Figure 2.
Figure 2.. Imaging characteristics of HCM patients with and without atrial fibrillation.
Assessment of LVEF by TTE; B. Assessment of LVEF by CMR; C. Comparison of chamber dimension and LV wall thickness assessed by TTE; D. Comparison of chamber dimension and LV wall thickness assessed by CMR. **p<0.001 HCM, hypertrophic cardiomyopathy; LVEF, left ventricular ejection fraction; CMR, cardiac MRI; TTE, transthoracic echocardiogram; LVEDD, left ventricular end diastolic dimension; LVESD, left ventricular end systolic dimension; IVSD, interventricular septal dimension; PWT, posterior wall thickness.
See this image and copyright information in PMC

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