P373 INCIDENCE OF EMBOLIC EVENTS IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY AND ATRIAL ARRYTHMIAS

Abstract

Abstract Background Atrial arrythmias (AA) are well–known major complications in HCM patients. Nevertheless, there are only a few studies investigating clinical features of HCM patients with AA who experienced embolic events (EVs). Methods We retrospectively collected clinical data from patients with HCM and atrial fibrillation or flutter followed at our Cardiology Department. The aim of this study was to assess the occurrence of EVs during long–term follow up. Results Among 702 HCM patients, 126 had AA: 79% AF (56% paroxysmal, 23% chronic), 6% AFL, 15 % both AF and AFL. Among those, 21 (16.7%) patients experienced at least one ischemic episode since HCM diagnosis and overall 29 ischemic events occurred (17 strokes, 11 TIAs, 1 lower limb embolism). 5 ischemic events occurred in 3 patients for whom no certain correlation with AA could be detected as the events occurred before the AA–diagnosis was performed. Therefore, they were excluded from the analysis. In the remaining 18 patients, age at first embolic event was 72 ± 5 years old. The mean CHA2DS2VASc score was 1.82 ± 1.16. We registered 24 EVs (15 strokes, 8 TIAs, 1 lower limb embolism) at a follow–up of 6.8 ± 5 years: in 5 (all >70 years old) the diagnosis of AA was done at the moment of the first EV, in 13 the embolism occurred at a mean time of 6.3 ± 4.5 years after the diagnosis of AA. Among the patients with previously diagnosed AA, in 8 the embolism happened despite proper anticoagulation (2 NOACs, 6 VKA), 2 were not in therapeutic range, 1 had temporary NOAC withdrawal for surgery and 2 started anticoagulation only after the embolic event occurred. 5 out of 18 patients (28%) had permanent neurological impairment and 1 patient died of stroke. The independent predictors of the first embolic event in patients with a previous diagnosis of AA were female sex (p = 0.017) and inappropriate anticoagulation (p = 0.002). CHA2DS2VASc score (1.85 ± 1.19 in EVs vs 1.81 ± 1.16 in no EVs) was not a predictor of embolism (p = 0.167). Conclusions In our cohort of HCM patients with AA, embolic events are frequent regardless of CHA2DS2VASc score. Therefore, anticoagulation should be started immediately after the first arrhythmic episode as recommended by most recent guidelines.