PO-02-157 IMPACT OF ATRIAL FIBRILLATION ON QUALITY OF LIFE IN HYPERTROPHIC CARDIOMYOPATHY

Abstract

In hypertrophic cardiomyopathy (HCM) atrial fibrillation (AF) has been historically described as unrelenting, a driver for heart failure, with a decisive impact on quality of life. AF treatment has been deemed less effective in HCM due to high rates of AF recurrence. However, AF has predominantly been characterized from physicians perspective and there is no data on impact on patient reported outcome measures (PROMs). To evaluate the impact of AF on PROMs in HCM. PROMs were collected using the Atrial Fibrillation Severity Scale (AFSS) and Kansas City Cardiomyopathy Questionnaire overall summary (KCCQ-OS) reflecting symptom burden and quality of life in 250 consecutive HCM patients. Among the 250 patients, 51 (20%) were diagnosed with AF at 56±10 years of age, 6.5±5.5 years prior to evaluation and reported health status. At evaluation, 45 of the 51 AF patients (88%) were in sinus rhythm, and 6 in AF (12%) including 5 in permanent AF. Each of the 51 patients required AF treatment for symptoms: 27 (53%) solely with medications (17 with AV nodal medications and 10 on antiarrhythmic drugs); and 24 (47%) with AF ablation (16 with catheter ablation and 8 surgical Cox-Maze IV at time of myectomy). Of the 24 AF ablation patients, 15 (63%) had recurrent AF including 6 (25%) requiring multiple ablation procedures. After most recent ablation, AF burden was reported as infrequent ≤1 episode per month in 17 (71%), including 10 with ≤1 episode/year. 75% had AFSS symptom score consistent with mild symptoms, and 91% had KCCQ-OS with mild or no disability. There was no difference in either KCCQ-OS or AFSS in patients with and without AF recurrence after ablation (p=0.68). The 27 patients treated solely with medications each had recurrent AF episodes on current therapy, but 15 (56%) reported infrequent AF burden ≤1 per month including 11 with ≤1 episode/year. With treatment, 67% had AFSS symptom score consistent with mild symptoms and 82% had KCCQ-OS with mild or no disability. There was no difference in KCCQ-OS in the 51 HCM patients with AF compared to 199 patients without AF (p=0.2). Recurrent AF in HCM is common despite treatment, however episodes tend to be infrequent. With treatment, the majority of patients with AF have no or mild symptom burden. These data support that despite recurrent AF episodes after treatment, quality of life metrics are not significantly impaired for most HCM patients.