Author + information
- Anais Hausvater,
- Ethan Rowin,
- Mark Link,
- Patrick Abt,
- William Gionfriddo,
- N.A. Mark Estes III,
- Wendy Wang,
- Barry Maron and
- Martin Maron
Background: Atrial fibrillation (AF) is the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM), producing symptoms in 20% of patients. However, impact of AF on clinical course and outcome in HCM is uncertain and has been controversial.
Methods: Records of 1269 consecutive patients followed at the Tufts Medical Center Hypertrophic Cardiomyopathy Institute, 2004 to 2014, were accessed; 250 (20%) had incurred symptomatic episodes of AF and were followed for 7.5 ± 6.2 years.
Results: Initial AF episode occurred at 53 ± 14 years, including 40 (16%) < 40 years; 68% male. Of the 250 patients 192 (77%) had paroxysmal episodes (average number 5 ± 5; range 1 to > 20 episodes), while 58 (23%) developed permanent AF. In patients with limiting symptoms while in AF (n=174, 70%), attempts were made to maintain sinus rhythm using antiarrhythmics (amiodarone [n=94], sotalol [n=71], disopyramide [n=53], and dofetilide [n=27]), AF radiofrequency ablation (n=36), or MAZE procedure at surgical myectomy (n=68). Recurrent AF occurred after radiofrequency ablation in 24 (66%) but in only 18 (26%) after MAZE procedure (p<0.001). Among the 190 patients (76%) on anticoagulation therapy, only 3 non-fatal embolic events occurred, while 13 other patients not on anticoagulation had an embolic event, including 1 who died of a stroke
Of the 250 patients, 8 died of HCM related causes (3%), including embolic stroke (n=1), end-stage heart failure (n=4), sudden death (n=2), and post-operative myectomy (n=1); 231 are alive (92%) with 91% in NYHA class I or II at age 55 ± 14 years. HCM-related mortality rate was 0.6 %/year with mortality attributable to AF only 0.1 %/year.
Conclusions: In contrast to prevailing perceptions, AF in HCM is associated with low cardiovascular mortality (≤0.6%/year) including as a consequence of embolic stroke. Non-fatal embolic stroke rates were low in prophylactically anti-coagulated patients. AF can impair quality of life in HCM patients, but is treatable and compatible with extended longevity.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias and Clinical EP: Basic 2
Abstract Category: 4. Arrhythmias and Clinical EP: Basic
Presentation Number: 1152-112
- 2017 American College of Cardiology Foundation