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==Atrial Fibrillation and Hypertrophic Cardiomyopathy==
==Atrial Fibrillation and Hypertrophic Cardiomyopathy==
*In [[patients]] with [[hypertrophic cardiomyopathy]] ([[hypertrophic cardiomyopathy|HCM]]), some factors such as, [[atrial fibrillation]], [[old age|advanced age]], [[hypertension]], [[mitral annular calcification]], and [[atrium|left atrial enlargment]] contribute to [[Embolism|systemic embolism]].<ref name="pmid7259379">Bar-Sela S, Ehrenfeld M, Eliakim M (1981) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7259379 Arterial embolism in thyrotoxicosis with atrial fibrillation.] ''Arch Intern Med'' 141 (9):1191-2. PMID: [http://pubmed.gov/7259379 7259379]</ref><ref name="pmid492021">Yuen RW, Gutteridge DH, Thompson PL, Robinson JS (1979) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=492021 Embolism in thyrotoxic atrial fibrillation.] ''Med J Aust'' 1 (13):630-1. PMID: [http://pubmed.gov/492021 492021]</ref><ref name="pmid6946758">Hurley DM, Hunter AN, Hewett MJ, Stockigt JR (1981) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6946758 Atrial fibrillation and arterial embolism in hyperthyroidism.] ''Aust N Z J Med'' 11 (4):391-3. PMID: [http://pubmed.gov/6946758 6946758]</ref><ref name="pmid492021">Yuen RW, Gutteridge DH, Thompson PL, Robinson JS (1979) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=492021 Embolism in thyrotoxic atrial fibrillation.] ''Med J Aust'' 1 (13):630-1. PMID: [http://pubmed.gov/492021 492021]</ref><ref name="pmid902055">Staffurth JS, Gibberd MC, Fui SN (1977) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=902055 Arterial embolism in thyrotoxicosis with atrial fibrillation.] ''Br Med J'' 2 (6088):688-90. PMID: [http://pubmed.gov/902055 902055]</ref><ref name="pmid7259379">Bar-Sela S, Ehrenfeld M, Eliakim M (1981) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7259379 Arterial embolism in thyrotoxicosis with atrial fibrillation.] ''Arch Intern Med'' 141 (9):1191-2. PMID: [http://pubmed.gov/7259379 7259379]</ref>  
*In [[patients]] with [[hypertrophic cardiomyopathy]] ([[hypertrophic cardiomyopathy|HCM]]), some factors such as, [[atrial fibrillation]], [[old age|advanced age]], [[hypertension]], [[mitral annular calcification]], and [[atrium|left atrial enlargment]] contribute to [[Embolism|systemic embolism]].<ref name="pmid7259379">Bar-Sela S, Ehrenfeld M, Eliakim M (1981) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7259379 Arterial embolism in thyrotoxicosis with atrial fibrillation.] ''Arch Intern Med'' 141 (9):1191-2. PMID: [http://pubmed.gov/7259379 7259379]</ref><ref name="pmid492021">Yuen RW, Gutteridge DH, Thompson PL, Robinson JS (1979) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=492021 Embolism in thyrotoxic atrial fibrillation.] ''Med J Aust'' 1 (13):630-1. PMID: [http://pubmed.gov/492021 492021]</ref><ref name="pmid6946758">Hurley DM, Hunter AN, Hewett MJ, Stockigt JR (1981) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6946758 Atrial fibrillation and arterial embolism in hyperthyroidism.] ''Aust N Z J Med'' 11 (4):391-3. PMID: [http://pubmed.gov/6946758 6946758]</ref><ref name="pmid492021">Yuen RW, Gutteridge DH, Thompson PL, Robinson JS (1979) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=492021 Embolism in thyrotoxic atrial fibrillation.] ''Med J Aust'' 1 (13):630-1. PMID: [http://pubmed.gov/492021 492021]</ref><ref name="pmid902055">Staffurth JS, Gibberd MC, Fui SN (1977) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=902055 Arterial embolism in thyrotoxicosis with atrial fibrillation.] ''Br Med J'' 2 (6088):688-90. PMID: [http://pubmed.gov/902055 902055]</ref><ref name="pmid7259379">Bar-Sela S, Ehrenfeld M, Eliakim M (1981) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7259379 Arterial embolism in thyrotoxicosis with atrial fibrillation.] ''Arch Intern Med'' 141 (9):1191-2. PMID: [http://pubmed.gov/7259379 7259379]</ref>  
*[[Atrial fibrillation]] has been shown to be associated with an increased risk for [[hypertrophic cardiomyopathy|hypertrophic cardiomyopathy related death]] ''(odds ratio 3.7; P<0.002)'' secondary to excess [[heart failure]]-related [[mortality rate|mortality]] but it is not associated to [[sudden cardiac death]].  
*[[Atrial fibrillation]] has been shown to be associated with an increased risk for [[hypertrophic cardiomyopathy|hypertrophic cardiomyopathy related death]] ''(odds ratio 3.7; P<0.002)'' secondary to excess [[heart failure]]-related [[mortality rate|mortality]] but it is not associated to [[sudden cardiac death]].<ref name="pmid24965028">{{cite journal| author=Siontis KC, Geske JB, Ong K, Nishimura RA, Ommen SR, Gersh BJ| title=Atrial fibrillation in hypertrophic cardiomyopathy: prevalence, clinical correlations, and mortality in a large high-risk population. | journal=J Am Heart Assoc | year= 2014 | volume= 3 | issue= 3 | pages= e001002 | pmid=24965028 | doi=10.1161/JAHA.114.001002 | pmc=4309084 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24965028  }} </ref>
*[[Hypertrophic cardiomyopathy]] [[patients]] with [[atrial fibrillation]] has a worse [[prognosis]], compared to those without [[atrial fibrillation]], even in when [[risk factors]] are corrected. <ref name="pmid24965028">{{cite journal| author=Siontis KC, Geske JB, Ong K, Nishimura RA, Ommen SR, Gersh BJ| title=Atrial fibrillation in hypertrophic cardiomyopathy: prevalence, clinical correlations, and mortality in a large high-risk population. | journal=J Am Heart Assoc | year= 2014 | volume= 3 | issue= 3 | pages= e001002 | pmid=24965028 | doi=10.1161/JAHA.114.001002 | pmc=4309084 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24965028  }} </ref>
*[[Atrial fibrillation]] [[patients]] were also at an increased risk for [[stroke]] ''([[odds ratio]] 17.7; [[P-value|P]]=0.0001)'' and severe functional limitation ''(odds ratio for [[New york heart association functional classification|NYHA class III or IV]], 2.8; P<0.0001)''.<ref name="pmid11714644">Olivotto I, Cecchi F, Casey SA, Dolara A, Traverse JH, Maron BJ (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11714644 Impact of atrial fibrillation on the clinical course of hypertrophic cardiomyopathy.] ''Circulation'' 104 (21):2517-24. PMID: [http://pubmed.gov/11714644 11714644]</ref>  
*[[Atrial fibrillation]] [[patients]] were also at an increased risk for [[stroke]] ''([[odds ratio]] 17.7; [[P-value|P]]=0.0001)'' and severe functional limitation ''(odds ratio for [[New york heart association functional classification|NYHA class III or IV]], 2.8; P<0.0001)''.<ref name="pmid11714644">Olivotto I, Cecchi F, Casey SA, Dolara A, Traverse JH, Maron BJ (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11714644 Impact of atrial fibrillation on the clinical course of hypertrophic cardiomyopathy.] ''Circulation'' 104 (21):2517-24. PMID: [http://pubmed.gov/11714644 11714644]</ref>  
*[[Antiarrhythmic agent|Antiarrhythmic agents]] such as [[disopyramide]], [[propafenone]], and [[amiodarone]] may be used to prevent [[atrial fibrillation]] episodes and modulate the rate of [[ventricle|ventricular]] response in [[patients]] with [[HCM]].<ref name="pmid9843465">Deedwania PC, Singh BN, Ellenbogen K, Fisher S, Fletcher R, Singh SN (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9843465 Spontaneous conversion and maintenance of sinus rhythm by amiodarone in patients with heart failure and atrial fibrillation: observations from the veterans affairs congestive heart failure survival trial of antiarrhythmic therapy (CHF-STAT). The Department of Veterans Affairs CHF-STAT Investigators.] ''Circulation'' 98 (23):2574-9. PMID: [http://pubmed.gov/9843465 9843465]</ref>   
*[[Antiarrhythmic agent|Antiarrhythmic agents]] such as [[disopyramide]], [[propafenone]], and [[amiodarone]] may be used to prevent [[atrial fibrillation]] episodes and modulate the rate of [[ventricle|ventricular]] response in [[patients]] with [[HCM]].<ref name="pmid9843465">Deedwania PC, Singh BN, Ellenbogen K, Fisher S, Fletcher R, Singh SN (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9843465 Spontaneous conversion and maintenance of sinus rhythm by amiodarone in patients with heart failure and atrial fibrillation: observations from the veterans affairs congestive heart failure survival trial of antiarrhythmic therapy (CHF-STAT). The Department of Veterans Affairs CHF-STAT Investigators.] ''Circulation'' 98 (23):2574-9. PMID: [http://pubmed.gov/9843465 9843465]</ref>   

Revision as of 06:14, 9 September 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S., Dima Nimri, M.D. [3]

Overview

Atrial Fibrillation and Hypertrophic Cardiomyopathy

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[8]

Hypertrophic Cardiomyopathy (DO NOT EDIT)[8]

Class I
"1. Anticoagulation is indicated in patients with hypertrophic cardiomyopathy (HCM) with atrial fibrillation independent of the CHA2DS2-VASc score. (Level of Evidence: B)"
Class IIa
"1. Antiarrhythmic medications can be useful to prevent recurrent atrial fibrillation in patients with hypertrophic cardiomyopathy (HCM). Amiodarone, or disopyramide combined with a beta blocker or nondihydropyridine calcium channel antagonists are reasonable therapies. (Level of Evidence: C)"
"2. Atrial fibrillation catheter ablation can be beneficial in patients with hypertrophic cardiomyopathy (HCM) in whom a rhythm-control strategy is desired when antiarrhythmic drugs fail or are not tolerated. (Level of Evidence: B)"
Class IIb
"1. Sotalol, dofetilide, and dronedarone may be considered for a rhythm-control strategy in patients with hypertrophic cardiomyopathy (HCM). (Level of Evidence: C)"

2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy[9]

Management of Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy

Class I
"1. Anticoagulation with vitamin K antagonists (i.e., warfarin, to an international normalized ratio of 2.0 to 3.0) is indicated in patients with paroxysmal, persistent, or chronic atrial fibrillation and hypertrophic cardiomyopathy (HCM). (Anticoagulation with direct thrombin inhibitors (such as dabigatran) may represent another option to reduce the risk of thromboembolic events, but data for patients with hypertrophic cardiomyopathy (HCM) are not available)(Level of Evidence: C)"
"2. Ventricular rate control in patients with hypertrophic cardiomyopathy (HCM) with atrial fibrillation is indicated for rapid ventricular rates and can require high doses of beta blockers and nondihydropyridine calcium channel blockers.(Level of Evidence: C)"
Class IIa
"1. Disopyramide (with a ventricular rate-controlling agents) and amiodarone are reasonable antiarrhythmic agents for atria fibrillation in patients with hypertrophic cardiomyopathy (HCM) (Level of Evidence: B)"
"2. Radiofrequency ablation for atrial fibrillation can be beneficial in patients with hypertrophic cardiomyopathy (HCM) who have refractory symptoms or who are unable to take antiarrhythmic agents (Level of Evidence: B)"
"3. Maze procedure with closure of left atrial appendage is reasonable in patients with hypertrophic cardiomyopathy (HCM) with a history of atrial fibrillation, either during septal myectomy or as an isolated procedure in selected patients. ([[ACC AHA guidelines clas]sification scheme#Level of Evidence|Level of Evidence: C]])"
Class IIb
"1. Sotalol, dofetilide, and dronedarone might be considered alternative antiarrhythmic agents in patients with hypertrophic cardiomyopathy (HCM), especially in those with an implantable cardioverter defibrillator (ICD), but clinical experience is limited. (Level of Evidence: C)"

2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[10]

Hypertrophic Cardiomyopathy (DO NOT EDIT) [10]

Class I
"1. Oral anticoagulation (INR 2.0 to 3.0) is recommended in patients with hypertrophic cardiomyopathy who develop atrial fibrillation, as for other patients at high risk of thromboembolism. (Level of Evidence: B)"
Class IIa
"1. Antiarrhythmic agents can be useful to prevent recurrent atrial fibrillation in patients with hypertrophic cardiomyopathy. Available data are insufficient to recommend one agent over another in this situation, but (a) disopyramide combined with a beta blocker or non dihydropyridine calcium channel antagonist or (b) amiodarone alone is generally preferred. (Level of Evidence: C)"

Sources

References

  1. ↑ 1.0 1.1 Bar-Sela S, Ehrenfeld M, Eliakim M (1981) Arterial embolism in thyrotoxicosis with atrial fibrillation. Arch Intern Med 141 (9):1191-2. PMID: 7259379
  2. ↑ 2.0 2.1 Yuen RW, Gutteridge DH, Thompson PL, Robinson JS (1979) Embolism in thyrotoxic atrial fibrillation. Med J Aust 1 (13):630-1. PMID: 492021
  3. ↑ Hurley DM, Hunter AN, Hewett MJ, Stockigt JR (1981) Atrial fibrillation and arterial embolism in hyperthyroidism. Aust N Z J Med 11 (4):391-3. PMID: 6946758
  4. ↑ Staffurth JS, Gibberd MC, Fui SN (1977) Arterial embolism in thyrotoxicosis with atrial fibrillation. Br Med J 2 (6088):688-90. PMID: 902055
  5. ↑ 5.0 5.1 Siontis KC, Geske JB, Ong K, Nishimura RA, Ommen SR, Gersh BJ (2014). "Atrial fibrillation in hypertrophic cardiomyopathy: prevalence, clinical correlations, and mortality in a large high-risk population". J Am Heart Assoc. 3 (3): e001002. doi:10.1161/JAHA.114.001002. PMC 4309084. PMID 24965028.
  6. ↑ Olivotto I, Cecchi F, Casey SA, Dolara A, Traverse JH, Maron BJ (2001) Impact of atrial fibrillation on the clinical course of hypertrophic cardiomyopathy. Circulation 104 (21):2517-24. PMID: 11714644
  7. ↑ Deedwania PC, Singh BN, Ellenbogen K, Fisher S, Fletcher R, Singh SN (1998) Spontaneous conversion and maintenance of sinus rhythm by amiodarone in patients with heart failure and atrial fibrillation: observations from the veterans affairs congestive heart failure survival trial of antiarrhythmic therapy (CHF-STAT). The Department of Veterans Affairs CHF-STAT Investigators. Circulation 98 (23):2574-9. PMID: 9843465
  8. ↑ 8.0 8.1 January, C. T.; Wann, L. S.; Alpert, J. S.; Calkins, H.; Cleveland, J. C.; Cigarroa, J. E.; Conti, J. B.; Ellinor, P. T.; Ezekowitz, M. D.; Field, M. E.; Murray, K. T.; Sacco, R. L.; Stevenson, W. G.; Tchou, P. J.; Tracy, C. M.; Yancy, C. W. (2014). "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society". Circulation. doi:10.1161/CIR.0000000000000041. ISSN 0009-7322.
  9. ↑ Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW (2011). "2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". J. Thorac. Cardiovasc. Surg. 142 (6): 1303–38. doi:10.1016/j.jtcvs.2011.10.019. PMID 22093712.
  10. ↑ 10.0 10.1 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA; et al. (2011). "2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". J Am Coll Cardiol. 57 (11): e101–98. doi:10.1016/j.jacc.2010.09.013. PMID 21392637.
  11. ↑ Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114 (7):e257-354. DOI:10.1161/CIRCULATIONAHA.106.177292 PMID: 16908781
  12. ↑ Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 123 (10):e269-367. DOI:10.1161/CIR.0b013e318214876d PMID: 21382897
  13. ↑ Estes NA, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS et al. (2008) ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation): developed in collaboration with the Heart Rhythm Society. Circulation 117 (8):1101-20. DOI:10.1161/CIRCULATIONAHA.107.187192 PMID: 18283199

CME Category::Cardiology

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