Atrial Fibrillation in Hypertrophic Cardiomyopathy
New Light on an Old Problem
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Article, see p 2420
Atrial fibrillation (AF) is the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM). It is reported by ≈20% of patients evaluated at referral centers and is more frequent in older patients and patients with left ventricular (LV) outflow obstruction.1,2 Despite the relatively high incidence of AF in HCM and the morbidity associated with this arrhythmia, only a small number of studies have systematically addressed the clinical implications of AF in HCM, with many being published more than a decade ago.2,3 More recent investigations were based on multicenter study designs and were confined mainly to comparisons of patients with HCM with or without AF.4–6
In this issue of Circulation, Rowin et al7 from Tufts Medical Center report their findings on the clinical course and management of AF in an HCM cohort of >300 consecutive patients with clinically overt AF who were part of an HCM population of almost 1600 patients evaluated at their referral center over a period of 10 years. The mean period of follow-up was ≈5 years. Of the patients with AF, 74% had symptomatic paroxysmal AF and 26% had permanent AF. A series of important observations have emerged from this large cohort of patients with access to contemporary management of HCM.
A novel and important observation, which differs considerably from most of the previous HCM literature, is the generally favorable clinical course and outcome in the great majority of the study patients with …