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Atrial fibrillation in hypertrophic cardiomyopathy: prevalence, clinical impact, and management

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Abstract

Hypertrophic cardiomyopathy (HCM) is the most common hereditary cardiomyopathy characterized by left ventricular hypertrophy and spectrum of clinical manifestation. Atrial fibrillation (AF) is a common sustained arrhythmia in HCM patients and is primarily related to left atrial dilatation and remodeling. There are several clinical, electrocardiographic (ECG), and echocardiographic (ECHO) features that have been associated with development of AF in HCM patients; strongest predictors are left atrial size, age, and heart failure class. AF can lead to progressive functional decline, worsening heart failure and increased risk for systemic thromboembolism. The management of AF in HCM patient focuses on symptom alleviation (managed with rate and/or rhythm control methods) and prevention of complications such as thromboembolism (prevented with anticoagulation). Finally, recent evidence suggests that early rhythm control strategy may result in more favorable short- and long-term outcomes.

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  1. Division of Cardiology, Lehigh Valley Health Network, 1200 S. Cedar Crest Blvd, Allentown, PA, 18103, USA

    Lohit Garg, Syed Rafay Ali Sabzwari, Talha Nazir, Jeffrey Gordon, Babak Bozorgnia & Matthew W. Martinez

  2. Maulana Azad Medical College, Delhi, 110092, India

    Manasvi Gupta

  3. Division of Cardiology, Brown University, Providence, RI, 02903, USA

    Sahil Agrawal

  4. Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, TN, 38163, USA

    Manyoo Agarwal

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  1. Lohit Garg
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Garg, L., Gupta, M., Sabzwari, S.R.A. et al. Atrial fibrillation in hypertrophic cardiomyopathy: prevalence, clinical impact, and management. Heart Fail Rev 24, 189–197 (2019). https://doi.org/10.1007/s10741-018-9752-6

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