Patricia Alphonse1, Sohaib Virk1, Jhonna Collins2, Timothy Campbell1,3, Stuart P Thomas1,3, Christopher Semsarian4, Saurabh Kumar5,6. 1. Department of Cardiology, Westmead Hospital, Corner Hawkesbury and Darcy Roads, Westmead, Sydney, NSW, 2145, Australia. 2. Nepean Clinical School, University of Sydney, Sydney, Australia. 3. Westmead Applied Research Centre, University of Sydney, Sydney, Australia. 4. Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, Department of Cardiology, The University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia. 5. Department of Cardiology, Westmead Hospital, Corner Hawkesbury and Darcy Roads, Westmead, Sydney, NSW, 2145, Australia. Saurabh.kumar@sydney.edu.au. 6. Westmead Applied Research Centre, University of Sydney, Sydney, Australia. Saurabh.kumar@sydney.edu.au.
Abstract
BACKGROUND: Atrial fibrillation (AF) is an important arrhythmia in hypertrophic cardiomyopathy (HCM). OBJECTIVES: To conduct a systematic review of published literature to: (a) assess the incidence of AF in HCM and (b) examine the impact of AF on risk of thromboembolism, heart failure, sudden death and mortality in HCM. METHODS: Search of all major databases (Pubmed, MEDLINE, Embase, Cochrane, Scopus, Web of Science) was performed to April 2020 using the search terms "atrial fibrillation" AND/OR "hypertrophic cardiomyopathy" in the title or abstract. 51 of the 1,565 citations met the inclusion criteria. RESULTS: Using random-effects modelling, the estimated pooled prevalence of AF amongst 21,887 HCM patients (36 studies) was 22.3% (95%, 19.9-24.8) and the pooled incidence of AF was 2.5 cases per person-years (95% CI 1.9-3.0). 15,444 patients from 28 studies were included in analysis of outcome data (mean age was 49.9 years; 32.7% female; mean LVEF 69%). Over a median follow up duration of 6.9 years (range 2.8-11.7 years), AF, compared to sinus rhythm (SR), was associated with significantly increased risk of thromboembolism [relative risk (RR) 7.0; 95% CI 4.6-10.7; I2 = 57%], heart failure (RR 2.8; 95% CI 1.6-4.6; I2 = 82%), sudden death (RR 1.7; 95% CI 1.3-2.3; I2 = 0%), and all-cause mortality (RR 2.5; 95% CI 1.8-3.4; I2 = 69%). CONCLUSIONS: AF is highly prevalent in patients with HCM. The presence of AF is associated with major adverse clinical outcomes. These findings suggest that both, aggressive screening and treatment of AF, are likely to have major prognostic impact on outcomes in HCM. Incidence, prevalence and prognostic impact of AF in HCM. In this systematic review, AF incidence was 2.5 cases per-person years, prevalence was 22.3%. AF in HCM was associated with a seven-fold increased risk of thromboembolism, 2.8-fold increased risk of heart failure, 1.7-fold increased risk of sudden death and 2.5-fold increased risk of all-cause mortality.
BACKGROUND:Atrial fibrillation (AF) is an important arrhythmia in hypertrophic cardiomyopathy (HCM). OBJECTIVES: To conduct a systematic review of published literature to: (a) assess the incidence of AF in HCM and (b) examine the impact of AF on risk of thromboembolism, heart failure, sudden death and mortality in HCM. METHODS: Search of all major databases (Pubmed, MEDLINE, Embase, Cochrane, Scopus, Web of Science) was performed to April 2020 using the search terms "atrial fibrillation" AND/OR "hypertrophic cardiomyopathy" in the title or abstract. 51 of the 1,565 citations met the inclusion criteria. RESULTS: Using random-effects modelling, the estimated pooled prevalence of AF amongst 21,887 HCM patients (36 studies) was 22.3% (95%, 19.9-24.8) and the pooled incidence of AF was 2.5 cases per person-years (95% CI 1.9-3.0). 15,444 patients from 28 studies were included in analysis of outcome data (mean age was 49.9 years; 32.7% female; mean LVEF 69%). Over a median follow up duration of 6.9 years (range 2.8-11.7 years), AF, compared to sinus rhythm (SR), was associated with significantly increased risk of thromboembolism [relative risk (RR) 7.0; 95% CI 4.6-10.7; I2 = 57%], heart failure (RR 2.8; 95% CI 1.6-4.6; I2 = 82%), sudden death (RR 1.7; 95% CI 1.3-2.3; I2 = 0%), and all-cause mortality (RR 2.5; 95% CI 1.8-3.4; I2 = 69%). CONCLUSIONS:AF is highly prevalent in patients with HCM. The presence of AF is associated with major adverse clinical outcomes. These findings suggest that both, aggressive screening and treatment of AF, are likely to have major prognostic impact on outcomes in HCM. Incidence, prevalence and prognostic impact of AF in HCM. In this systematic review, AF incidence was 2.5 cases per-person years, prevalence was 22.3%. AF in HCM was associated with a seven-fold increased risk of thromboembolism, 2.8-fold increased risk of heart failure, 1.7-fold increased risk of sudden death and 2.5-fold increased risk of all-cause mortality.
Authors: Ahmad Masri; Mohamed Kanj; Maran Thamilarasan; Oussama Wazni; Nicholas G Smedira; Harry M Lever; Milind Y Desai Journal: Cardiovasc Diagn Ther Date: 2017-02
Authors: Oliver P Guttmann; Menelaos Pavlou; Constantinos O'Mahony; Lorenzo Monserrat; Aristides Anastasakis; Claudio Rapezzi; Elena Biagini; Juan Ramon Gimeno; Giuseppe Limongelli; Pablo Garcia-Pavia; William J McKenna; Rumana Z Omar; Perry M Elliott Journal: Eur J Heart Fail Date: 2015-07-16 Impact factor: 15.534
Authors: Konstantinos C Siontis; Jeffrey B Geske; Kevin Ong; Rick A Nishimura; Steve R Ommen; Bernard J Gersh Journal: J Am Heart Assoc Date: 2014-06-25 Impact factor: 5.501