Predictors and Mechanisms of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy
Section snippets
Methods
From December 2003 to April 2013, consecutive patients referred with a diagnosis of known or suspected HC underwent a CMR scan including myocardial perfusion and late gadolinium enhancement at the Royal Brompton Hospital in London UK. All patients met the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) diagnostic criteria for HC.11 Exclusion criteria were previous or current AF, metabolic diseases resulting in HC phenocopies such as Anderson-Fabry disease,
Results
A total of 377 patients (mean age 62 ± 14, 73% male) were recruited. Exclusions were prior or current AF (n = 18, 5%), inadequate baseline data (n = 5, 1%) and patients lost to follow up (n = 6, 2%), giving a final population of 348 patients (Figure 1, Table 1).
The median follow-up period was 4.5 years (2.9, 6.0) with a total of 1532 patient-years of follow-up. During follow-up, 62 patients (16%) developed new AF. The incidence of AF was 4.0 (CI: 3.2 to 5.2) per 100 person-years. There were 22
Discussion
Patients with HC who develop AF are known to be at increased risk for heart failure and thromboembolic events, including stroke. We demonstrated that the extent of myocardial fibrosis and LA volume determined by CMR were strong independent predictors of AF. Our results suggest that myocardial replacement fibrosis may have a mechanistic role in development of AF. We formulated a risk prediction that may be used to identify high risk patients. Compared with those with minimal or no LGE and LAVi
Authors Contribution
Conceptualization and methodology: SKP, DJP, ROH. Investigation: CER, ACL, FM, GSK, FRA, EDP. Formal analysis: SN, RO, JG. Writing – original draft: ACL, CER. Writing – Review and Editing – RC, PGm VV, SE, MF
References (28)
- et al.
Atrial fibrillation in hypertrophic cardiomyopathy: a longitudinal study
J Am Coll Cardiol
(1990) - et al.
Predictors of future onset of atrial fibrillation in hypertrophic cardiomyopathy
Arch Cardiovasc Dis
(2018) - et al.
Cardiac magnetic resonance in hypertrophic cardiomyopathy
JACC Cardiovasc Imaging
(2011) - et al.
Best method in clinical practice and in research studies to determine left atrial size
Am J Cardiol
(1999) - et al.
Evaluation of techniques for the quantification of myocardial scar of differing etiology using cardiac magnetic resonance
JACC Cardiovasc Imaging
(2011) - et al.
The influence of left ventricular filling pressure on atrial contribution to cardiac output
Am Heart J
(1979) - et al.
Atrial fibrosis: mechanisms and clinical relevance in atrial fibrillation
J Am Coll Cardiol
(2008) - et al.
Hypertrophic cardiomyopathy patients with paroxysmal atrial fibrillation have a high burden of left atrial fibrosis by cardiac magnetic resonance imaging
JACC Clin Electrophysiol
(2019) Molecular and cellular mechanisms of atrial fibrosis in atrial fibrillation
JACC Clin Electrophysiol
(2017)- et al.
Correlation between myocardial fibrosis and the occurrence of atrial fibrillation in hypertrophic cardiomyopathy: a cardiac magnetic resonance imaging study
Eur J Radiol
(2010)
Diabetes mellitus is a strong, independent risk for atrial fibrillation and flutter in addition to other cardiovascular disease
Int J Cardiol
Atrial fibrillation and thromboembolism in patients with hypertrophic cardiomyopathy: systematic review
Heart
Prevalence of atrial fibrillation in the general population and in high-risk groups: the ECHOES study
Europace
Impact of atrial fibrillation on the clinical course of hypertrophic cardiomyopathy
Circulation
Cited by (7)
Ventricular Septal Myectomy Decreases Long-Term Risk for Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy
2022, American Journal of CardiologyCitation Excerpt :Impact of myectomy on AF has remained unknown, and we demonstrate here that surgical myectomy also substantially reduces the risk for new-onset AF by about 30%. This risk reduction attributable to surgery occurred despite a higher baseline risk for AF.2,3,12–14 This favorable impact of myectomy on AF is likely explained by a previously documented reduction in left atrial size and pressure and mitral regurgitation after myectomy.15
Association between left ventricular reverse remodeling and long-term outcomes after alcohol septal ablation for hypertrophic obstructive cardiomyopathy
2023, International Journal of Cardiovascular ImagingAcute myocardial infarction occurring after hypertrophic obstructive cardiomyopathy with paroxysmal atrial fibrillation: a case report
2022, Journal of International Medical Research
Funding: The work was supported by CORDA and the Rosetrees Foundation Trust, United Kingdom. Dr. Raphael supported by a British Heart Foundation Clinical Research Training Fellowship, United Kingdom.
Disclosures: Dr. Pennell has received a grant from Siemens; is the Director of and shareholder with CVIS; and has received personal fees from Bayer. Dr. Prasad has received personal fees from Bayer-Schering. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- #
Joint first authors.