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Prognostic impact of atrial fibrillation in hypertrophic cardiomyopathy: a systematic review

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.

Graphic abstract

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.

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Abbreviations

HCM:

Hypertrophic cardiomyopathy

LV:

Left ventricular

AF:

Atrial fibrillation

RR:

Relative risk

OR:

Odds ratio

CI:

Confidence interval

LVEF:

Left ventricular ejection fraction

SR:

Sinus rhythm

LA:

Left atrium

ESC:

European Society of Cardiology

TOE:

Transoesophageal echocardiogram

ECG:

Electrocardiogram

MACE:

Major adverse cardiac event

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Funding

SK is a recipient of the NSW Health Early-Mid Career Fellowship. TC is a former employee of Biosense Webster, Inc and has received speakers’ honoraria for Biosense Webster, Inc in the last 12 months.

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Correspondence to Saurabh Kumar.

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The authors declare that they have no conflict of interest.

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Cite this article

Alphonse, P., Virk, S., Collins, J. et al. Prognostic impact of atrial fibrillation in hypertrophic cardiomyopathy: a systematic review. Clin Res Cardiol 110, 544–554 (2021). https://doi.org/10.1007/s00392-020-01730-w

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  • DOI: https://doi.org/10.1007/s00392-020-01730-w

Keywords

  • Hypertrophic cardiomyopathy
  • Atrial fibrillation
  • Morbidity
  • Mortality
  • Thromboembolism
  • Heart failure
  • Sudden death