Abstract
Hypertrophic cardiomyopathy (HCM) is an inherited cardiological condition that exhibits various clinical symptoms. The leading cause of atrial fibrillation (AF) in patients with HCM is advanced diastolic dysfunction and left atrial dilatation and remodeling. In addition to the gradual symptomatic and functional decline caused by AF, there is an increased risk of thromboembolic disease and mortality, especially if there is a rapid ventricular rate or obstruction of the left ventricular outflow tract. The mainstay of management of AF in HCM is a combination of non-pharmacological lifestyle and risk factor modification, long-term anticoagulation, and rhythm control with anti-arrhythmic medications, septal ablation, and radiofrequency catheter ablation. This article has examined the development of AF in HCM, its clinical symptomatology, and its impact, highlighting its management and the mortality associated with AF in HCM.
Highlights
Hypertrophic cardiomyopathy (HCM) is an umbrella term for a variegated heart disease defined by left ventricular hypertrophy (LVH) in the absence of any aberrant cardiac etiologies like hypertension or aortic stenosis [1]
Siontis KC et al conducted a retrospective analysis of >3500 patients with HCM from 1975 to 2012, and studies concluded that several echocardiographic markers in HCM patients like LV wall thickness and LV stiffness are associated with higher chances of developing Atrial fibrillation (AF) as a consequence of structural abnormalities precipitated by the disease [47]
As evident from the studies reviewed in this article, HCM causes structural changes in myocardial tissue, leading to the formation of AF
Summary
Hypertrophic cardiomyopathy (HCM) is an umbrella term for a variegated heart disease defined by left ventricular hypertrophy (LVH) in the absence of any aberrant cardiac etiologies like hypertension or aortic stenosis [1]. Siontis KC et al conducted a retrospective analysis of >3500 patients with HCM from 1975 to 2012, and studies concluded that several echocardiographic markers in HCM patients like LV wall thickness and LV stiffness are associated with higher chances of developing AF as a consequence of structural abnormalities precipitated by the disease [47]. Guttmann OP et al conducted a retrospective longitudinal cohort study from 1986 and 2008 They concluded that there is an eight-fold risk of TE in HCM patients with AF, and the development of TE is considered a poor predictive factor in the long-term prognostication of HCM [45,50]. Even though these have not explicitly included HCM patients, recommendations and treatment of underlying comorbidities like diabetes, hypertension, and sleep apnea should be undertaken to prevent AF
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