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Review
. 2024 Aug 20;3(9):101210.
doi: 10.1016/j.jacadv.2024.101210. eCollection 2024 Sep.

Atrial Fibrillation in Hypertrophic Cardiomyopathy

Adaya Weissler-Snir  1 , Sara Saberi  2 , Timothy C Wong  3 , Antonis Pantazis  4 , Anjali Owens  5 , Alexander Leunig  3 , Chikezie Alvarez  6 , Florian Rader  7
Affiliations
Review

Atrial Fibrillation in Hypertrophic Cardiomyopathy

Adaya Weissler-Snir et al. JACC Adv. .

Abstract

Atrial fibrillation (AF) is common among patients with hypertrophic cardiomyopathy (HCM) with a prevalence greater than 25%. AF in HCM is associated with a high risk of stroke and can be a marker of more advanced cardiomyopathy. Although, it frequently results in cardiac hemodynamic changes which are poorly tolerated, it can be subclinical. Thus, prompt diagnosis and adequate management of AF are essential to minimizing AF-related adverse outcomes in HCM. All HCM patients should be screened for AF regularly, and those with high-risk features should be screened more frequently preferably with extended ambulatory monitoring. Once AF is detected, oral anticoagulation should be initiated. Both general and HCM-specific modifiable risk factors should be addressed and assessment for cardiomyopathy progression should be performed. Although no randomized controlled studies have compared rate versus rhythm control in HCM, early rhythm control could be considered to prevent further LA remodeling.

Keywords: anti-coagulation; atrial fibrillation; hypertrophic cardiomyopathy; rate control; rhythm control.

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Conflict of interest statement

Dr Weissler-Snir has received speaker fees from Bristol Myer Squibb; and fees for publication steering committee participation for Cytokinetics and research grants from 10.13039/100004374Medtronic. Dr Rader has received consultant and speaker fees from Bristol Myer Squibbs, Medtronic, Recor Medical, and Cytokinetics. Dr Saberi has received consultant/advisor fees from Bristol Myers Squibb; and has received research grants from Bristol Myers Squibb, 10.13039/100014941Cytokinetics, 10.13039/100004336Novartis, and 10.13039/100005646Actelion Pharmaceuticals. Dr Wong is the site principal investigator for clinical trials sponsored by Bristol Myers Squibb, Cytokinetics, and Tenaya Therapeutics; and discloses unpaid advisory board participation for Bristol Myers Squibb and Cytokinetics. Dr Owens has received consulting/research support from 10.13039/100014941Cytokinetics, MyoKardia/Bristol Myers Squibb, Pfizer, Lexicon Pharmaceuticals, Tenaya Therapeutics, Stealth BioTherapeutics, Renovacor, Edgewise Therapeutics, BioMarin Pharmaceuticals, and Lexeo Therapeutics.

Figures

None
Graphical abstract
Figure 1
Figure 1
Anatomical Changes in HCM Contributing to AF Development (A) Dilated left atrium with spontaneous echo contrast. (B) A marked reduction in all left atrium strain components in the 4-chamber view is seen. The reservoir strain is 14% (white double arrow) and contractile strain is -5% (yellow double arrow). (C) Atrial myopathy with low left atrium appendage emptying velocities.
Figure 2
Figure 2
Cardiac and Noncardiac Factors Driving AF Development and its Consequences AF = atrial fibrillation; BNP = brain natriuretic peptide; HCM = hypertrophic cardiomyopathy; LA = left atrium; LAA = left atrium appendage; LVOTO = left ventricular outflow tract obstruction; LVEDP = left ventricular end-diastolic pressure; P/LP = pathogenic/likely pathogenic.
Central Illustration
Central Illustration
Approach to AF Screening and Management in HCM Patients AF = atrial fibrillation; CMR = cardiovascular magnetic resonance; CPET = cardiopulmonary exercise testing; DOAC = direct oral anticoagulants; FDA = Food and Drug Administration; HTN = hypertension; LA = left atrium; LVOTO = left ventricular outflow tract; OSA = obstructive sleep apnea.
See this image and copyright information in PMC

References

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