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Atrial Fibrillation in Hypertrophic Cardiomyopathy: Prevalence, Clinical Correlations, and Mortality in a Large High‐Risk Population

Siontis, Konstantinos C., Geske, Jeffrey B., Ong, Kevin, Nishimura, Rick A., Ommen, Steve R., Gersh, Bernard J.·2014·Journal of the American Heart Association
DOI 10.1161/jaha.114.001002PMC PMC4309084
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Abstract

Background: Atrial fibrillation ( AF ) is a common sequela of hypertrophic cardiomyopathy ( HCM ), but evidence on its prevalence, risk factors, and effect on mortality is sparse. We sought to evaluate the prevalence of AF , identify clinical and echocardiographic correlates, and assess its effect on mortality in a large high‐risk HCM population. Methods and Results: We identified HCM patients who underwent evaluation at our institution from 1975 to 2012. AF was defined by known history (either chronic or paroxysmal), electrocardiogram, or Holter monitoring at index visit. We examined clinical and echocardiographic variables in association with AF . The effect of AF on overall and cause‐specific mortality was evaluated with multivariate Cox proportional hazards models. Of 3673 patients with HCM , 650 (18%) had AF. Patients with AF were older and more symptomatic ( P <0.001). AF was less common among patients with obstructive HCM phenotype and was associated with larger left atria, higher E/e’ ratios, and worse cardiopulmonary exercise tolerance (all P values<0.001). During median (interquartile range) follow‐up of 4.1 (0.2 to 10) years, 1069 (29%) patients died. Patients with AF had worse survival compared to those without AF ( P <0.001). In multivariate analysis adjusted for established risk factors of mortality in HCM , the hazard ratio (95% confidence interval) for the effect of AF on overall mortality was 1.48 (1.27 to 1.71). AF did not have an effect on sudden or nonsudden cardiac death. Conclusions: In this large referral HCM population, approximately 1 in 5 patients had AF . AF was a strong predictor of mortality, even after adjustment for established risk factors.

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Crossref · 10.1161/jaha.114.001002

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Figure 1. Kaplan‐Meier's survival analysis for HCM patients with and without AF and expected survival of an age‐ and sex‐matched general U.S. population. Survival was worse in HCM patients with AF than those without AF (P<0.001), and, even in the absence of AF, it was worse than the expected survival of an age‐ and sex‐matched population (P<0.001). AF indicates atrial fibrillation; HCM, hypertrophic cardiomyopathy.
Figure 1. Kaplan‐Meier's survival analysis for HCM patients with and without AF and expected survival of an age‐ and sex‐matched general U.S. population. Survival was worse in HCM patients with AF than those without AF (P<0.001), and, even in the absence of AF, it was worse than the expected survival of an age‐ and sex‐matched population (P<0.001). AF indicates atrial fibrillation; HCM, hypertrophic cardiomyopathy.CC BY-NC · PubMed Central

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Research works printed but not linked: 33

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Metadata

Authors
Siontis, K. C., Geske, J. B., Ong, K., Nishimura, R. A., Ommen, S. R., & Gersh, B. J.
Venue
Journal of the American Heart Association
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2014-05-22
Volume
3
Issue
3
ISSN
2047-9980
DOI
10.1161/jaha.114.001002
PMC
PMC4309084
Cited by
276
References
4
Language
en

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