Bun Yashiro1, Yuichiro Minami2, Yutaka Terajima1, Nobuhisa Hagiwara1. 1. Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan. 2. Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan. Electronic address: yuichiro24@celery.ocn.ne.jp.
Abstract
BACKGROUND: The association of atrial fibrillation (AF) with sudden death and the difference in prognostic significance between paroxysmal and non-paroxysmal AF remains unclear in patients with hypertrophic cardiomyopathy (HCM). Our aim was to investigate the clinical significance of AF, and to assess the prognostic difference between paroxysmal and non-paroxysmal AF in HCM patients. METHODS: The study included 430 HCM patients. Documentation of AF was based on electrocardiograms obtained either after the acute onset of symptoms or fortuitously during routine examination of asymptomatic patients. RESULTS: AF was detected in 120 patients (27.9%). In the patients with AF, syncope and non-sustained ventricular tachycardia were more frequent and the left atrial dimension was larger. Multivariate analysis showed that AF was an independent determinant of the outcome, including the risk of HCM-related death (adjusted hazard ratio 3.57, p<0.001) and sudden death (adjusted hazard ratio 2.61, p=0.038). When patients with AF were divided into subgroups with paroxysmal AF (n=75) or non-paroxysmal AF (n=45), only paroxysmal AF was identified as an independent determinant of the outcome, including the risk of HCM-related death (adjusted hazard ratio 5.24, p<0.001) and sudden death (adjusted hazard ratio 4.67, p=0.002). CONCLUSIONS: AF is a common supraventricular arrhythmia in HCM and has an adverse influence on the prognosis. In addition, each type of AF had a different clinical impact, with paroxysmal AF being a significant independent determinant of an adverse outcome, including sudden death.
BACKGROUND: The association of atrial fibrillation (AF) with sudden death and the difference in prognostic significance between paroxysmal and non-paroxysmal AF remains unclear in patients with hypertrophic cardiomyopathy (HCM). Our aim was to investigate the clinical significance of AF, and to assess the prognostic difference between paroxysmal and non-paroxysmal AF in HCM patients. METHODS: The study included 430 HCM patients. Documentation of AF was based on electrocardiograms obtained either after the acute onset of symptoms or fortuitously during routine examination of asymptomatic patients. RESULTS:AF was detected in 120 patients (27.9%). In the patients with AF, syncope and non-sustained ventricular tachycardia were more frequent and the left atrial dimension was larger. Multivariate analysis showed that AF was an independent determinant of the outcome, including the risk of HCM-related death (adjusted hazard ratio 3.57, p<0.001) and sudden death (adjusted hazard ratio 2.61, p=0.038). When patients with AF were divided into subgroups with paroxysmal AF (n=75) or non-paroxysmal AF (n=45), only paroxysmal AF was identified as an independent determinant of the outcome, including the risk of HCM-related death (adjusted hazard ratio 5.24, p<0.001) and sudden death (adjusted hazard ratio 4.67, p=0.002). CONCLUSIONS:AF is a common supraventricular arrhythmia in HCM and has an adverse influence on the prognosis. In addition, each type of AF had a different clinical impact, with paroxysmal AF being a significant independent determinant of an adverse outcome, including sudden death.
Authors: Tiffany T S Ye; Qi Zhuang Siah; Benjamin Y Q Tan; Jamie S Y Ho; Nicholas L X Syn; Yao Hao Teo; Yao Neng Teo; James W Yip; Tiong-Cheng Yeo; Weiqin Lin; Raymond C C Wong; Ping Chai; Bernard Chan; Vijay Kumar Sharma; Leonard L L Yeo; Ching-Hui Sia Journal: J Thromb Thrombolysis Date: 2022-10-03 Impact factor: 5.221