Atrial Fibrillation and Stroke in Patients with Hypertrophic Cardiomyopathy: Important New Insights
Key result
Patients with hypertrophic cardiomyopathy and atrial fibrillation face a high stroke risk even without other CHA2DS2-VASc risk factors, supporting lifelong anticoagulation at the first evidence of atrial fibrillation.
Population
Patients with hypertrophic cardiomyopathy (HCM)
Design
Editorial
Authors
Discussion
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Implication
Highlights the pathophysiological continuum in hypertrophic cardiomyopathy leading to diastolic dysfunction, left atrial dilatation, and atrial fibrillation.
Key Points
- To review the pathophysiological progression of hypertrophic cardiomyopathy and elucidate the hemodynamic mechanisms predisposing patients to atrial fibrillation and stroke.
- Synthesized historical and clinical evidence detailing the phenotypic spectrum of hypertrophic cardiomyopathy beyond idiopathic hypertrophic subaortic stenosis.
- Evaluated the impact of echocardiographic advances on characterizing non-obstructive disease variants and left ventricular diastolic abnormalities.
- Hypertrophic cardiomyopathy represents the most common non-ischemic primary myocardial disease, presenting across a continuum of genetic anomalies often devoid of outflow obstruction.
- Left ventricular diastolic dysfunction acts as a primary hemodynamic impairment, triggering progressive left atrial dilatation that predisposes patients to atrial fibrillation.
Structured PICO
P
Population
Patients with hypertrophic cardiomyopathy (HCM)
Highlights the pathophysiological continuum in hypertrophic cardiomyopathy leading to diastolic dysfunction, left atrial dilatation, and atrial fibrillation.
Limitations
- Lack of prospective data on stroke incidence in HCM patients with AF
- Paucity of data on the utility of pharmacological anti-arrhythmic therapy or ablation versus anticoagulation
- Need for direct studies assessing the safety and efficacy of direct oral anticoagulants (DOACs) specifically in HCM
Cite This Study
Borer et al. (2019) conducted an editorial in Hypertrophic Cardiomyopathy and Atrial Fibrillation. Anticoagulation was evaluated. Patients with hypertrophic cardiomyopathy and atrial fibrillation face a high stroke risk even without other CHA2DS2-VASc risk factors, supporting lifelong anticoagulation at the first evidence of atrial fibrillation.