What is the clinical profile and prognostic impact of atrial fibrillation in patients with hypertrophic cardiomyopathy?
Atrial fibrillation in hypertrophic cardiomyopathy does not significantly increase disease-related mortality or sudden death when treated, though it carries a risk of embolic stroke supporting early anticoagulation.
Transient symptomatic episodes of AF, often responsible for impaired quality of life, are unpredictable in frequency and timing, but amenable to effective contemporary treatments, and infrequently progress to permanent AF. AF is not a major contributor to heart failure morbidity or a cause of arrhythmic sudden death; when treated, it is associated with low disease-related mortality, no different than for patients without AF. AF is an uncommon primary cause of death in HCM virtually limited to embolic stroke, supporting a low threshold for initiating anticoagulation therapy.
Rowin et al. (Sat,) studied this question.