Prognostic impact of atrial fibrillation in hypertrophic cardiomyopathy: a systematic review
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ORIGINAL PAPER
Prognostic impact of atrial fibrillation in hypertrophic cardiomyopathy: a systematic review Patricia Alphonse1 · Sohaib Virk1 · Jhonna Collins2 · Timothy Campbell1,3 · Stuart P. Thomas1,3 · Christopher Semsarian4 · Saurabh Kumar1,3 Received: 29 June 2020 / Accepted: 11 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Atrial fibrillation (AF) is an important arrhythmia in hypertrophic cardiomyopathy (HCM). Objectives To conduct a systematic review of published literature to: (a) assess the incidence of AF in HCM and (b) examine the impact of AF on risk of thromboembolism, heart failure, sudden death and mortality in HCM. Methods Search of all major databases (Pubmed, MEDLINE, Embase, Cochrane, Scopus, Web of Science) was performed to April 2020 using the search terms “atrial fibrillation” AND/OR “hypertrophic cardiomyopathy” in the title or abstract. 51 of the 1,565 citations met the inclusion criteria. Results Using random-effects modelling, the estimated pooled prevalence of AF amongst 21,887 HCM patients (36 studies) was 22.3% (95%, 19.9–24.8) and the pooled incidence of AF was 2.5 cases per person-years (95% CI 1.9–3.0). 15,444 patients from 28 studies were included in analysis of outcome data (mean age was 49.9 years; 32.7% female; mean LVEF 69%). Over a median follow up duration of 6.9 years (range 2.8–11.7 years), AF, compared to sinus rhythm (SR), was associated with significantly increased risk of thromboembolism [relative risk (RR) 7.0; 95% CI 4.6–10.7; I2 = 57%], heart failure (RR 2.8; 95% CI 1.6–4.6; I2 = 82%), sudden death (RR 1.7; 95% CI 1.3–2.3; I2 = 0%), and all-cause mortality (RR 2.5; 95% CI 1.8–3.4; I2 = 69%). Conclusions AF is highly prevalent in patients with HCM. The presence of AF is associated with major adverse clinical outcomes. These findings suggest that both, aggressive screening and treatment of AF, are likely to have major prognostic impact on outcomes in HCM.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00392-020-01730-w) contains supplementary material, which is available to authorized users. * Saurabh Kumar [email protected] 1
Department of Cardiology, Westmead Hospital, Corner Hawkesbury and Darcy Roads, Westmead, Sydney, NSW 2145, Australia
2
Nepean Clinical School, University of Sydney, Sydney, Australia
3
Westmead Applied Research Centre, University of Sydney, Sydney, Australia
4
Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, Department of Cardiology, The University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia
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Clinical Research in Cardiology
Graphic abstract Incidence, prevalence and prognostic impact of AF in HCM. In this systematic review, AF incidence was 2.5 cases per-person years, prevalence was 22.3%. AF in HCM was associated with a seven-fold increased risk of thromboembolism, 2.8-fold increased risk of heart failure, 1.7-fold increased risk of sudden death and 2.
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