February 13, 2019Open Access
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.
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
Abstract
Among the various non-ischaemic primary myocardial diseases recognized in humans, the most common is hypertrophic cardiomyopathy (HCM). Though first recognized more than 60 years ago because of the characteristic physical signs of its most dramatic form, idiopathic hypertrophic subaortic stenosis (IHSS),1 the rapid dissemination of the echocardiogram 10 years later soon led to the recognition that IHSS was merely a part of a continuum of genetically determined hypertrophic anomalies, often without outflow obstruction.2 The more characteristic haemodynamic abnormality is left ventricular diastolic dysfunction. This, in turn, can lead to left atrial dilatation which, if sufficiently severe, can contribute to the development of atrial fibrillation (AF).