RT Journal Article
SR Electronic
T1 Impact of atrial fibrillation on the clinical course of apical hypertrophic cardiomyopathy
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1496
OP 1501
DO 10.1136/heartjnl-2016-310720
VO 103
IS 19
A1 Sang-Eun Lee
A1 Jin-Kyu Park
A1 Jae-Sun Uhm
A1 Jong Youn Kim
A1 Hui-Nam Pak
A1 Moon-Hyoung Lee
A1 Boyoung Joung
YR 2017
UL http://heart.bmj.com/content/103/19/1496.abstract
AB 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.