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Original research article
Impact of atrial fibrillation on the clinical course of apical hypertrophic cardiomyopathy
  1. Sang-Eun Lee,
  2. Jin-Kyu Park,
  3. Jae-Sun Uhm,
  4. Jong Youn Kim,
  5. Hui-Nam Pak,
  6. Moon-Hyoung Lee,
  7. Boyoung Joung
  1. Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
  1. Correspondence to Professor Boyoung Joung, Yonsei University College of Medicine, 250 Seungsanno, Seodaemungu, Seoul 120-752, Republic of Korea; cby6908{at}


Background Apical hypertrophic cardiomyopathy (ApHCM) is considered a ‘benign’ form of hypertrophic cardiomyopathy, with limited data on the long-term outcome. However, the clinical impact of atrial fibrillation (AF) in ApHCM is largely unknown. The hypothesis was that AF is common and has a prognostic implication in ApHCM.

Methods The occurrence of AF and outcome was assessed in 306 consecutive patients with ApHCM (68% male, 62±11 years).

Results AF occurred in 77 patients with ApHCM (prevalence, 25.2%; annual incidence, 4.6%/year) and was independently predicted by old age and large left atrium (>45 mm). Among 70 AF patients indicated with anticoagulation, 53 patients (76%) received warfarin. During a follow-up of 5.5±2.0 years, the patients with AF had a higher incidence of all-cause death, cardiovascular death and strokes (11.7% vs 1.3%, 6.5% vs 0.9% and 19.5% vs 2.6%, respectively, all p<0.05) than those without AF. When adjusted by the age and gender, those with AF still had an increased risk for all-cause death (HR 6.58; 95% CI 1.65–26.16, p=0.007) and strokes (HR 5.13; 95% CI 1.85 to 14.18, p=0.002). AF was detected before the time of stroke in 8 (53%) out of 15 patients with both AF and stroke. In addition, six out of eight patients were on anticoagulation at the time of stroke. The cause of death was a stroke in three (33%) out of nine patients with AF.

Conclusion In patients with ApHCM, AF was common and was associated with a substantial risk for strokes and mortality suggesting that AF should be carefully managed in ApHCM.

  • apical hypertrophic cardiomyopathy
  • atrial fibrillation
  • stroke

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  • Contributors BJ and SEL designed and wrote the manuscript. JKP, JYK, HNP and MHL reviewed and gave the final consent to submit the manuscript.

  • Funding This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF2012R1A2A2A02045367, 20100021993) and grants from the Korean Healthcare technology R&D project funded by the Ministry of Health & Welfare (HI12C1552, HI16C0058, HI15C1200).

  • Competing interests None declared.

  • Patient consent This is a retrospective study.

  • Ethics approval Yonsei University College of Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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