Atrial fibrillation hypertrophic cardiomyopathy


 * Associate Editor(s)-In-Chief: ; Varun Kumar, M.B.B.S.

Synonyms and related keywords: AF, Afib, fib

Overview
In patients with hypertrophic cardiomyopathy (HOCM), the factors that contribute to systemic embolism   include  atrial fibrillation, advanced age, hypertension, mitral annular calcification, and left atrial enlargment. AF has been shown to be associated with an increased risk for HCM-related death (odds ratio 3.7; P<0.002) secondary to excess heart failure-related mortality but not sudden cardiac death. AF patients were also at an increased risk for stroke (odds ratio 17.7; P=0.0001) and severe functional limitation (odds ratio for NYHA class III or IV, 2.8; P<0.0001). Antiarrhythmic agents such as disopyramide, propafenone, and amiodarone may be used to prevent AF episodes and modulate the rate of ventricular response in patients with HOCM. The medical management of the patient with hypertrophic cardiomyopathy involves minimizing diastolic dysfunction, reducing left ventricular outflow tract obstruction, optimizing heart failure management, maintaining normal sinus rhythm, rate control and anticoagulation in the presence of atrial fibrillation, and implantation of an automatic implantable cardiac defibrillator in those patients who survive sudden cardiac death.

==ACCF/AHA/HRS 2011 Guidelines- Hypertrophic Cardiomyopathy (DO NOT EDIT) == {{cquote|

Class I
1. Oral anticoagulation (INR 2.0 to 3.0) is recommended in patients with hypertrophic cardiomyopathy who develop AF, as for other patients at high risk of thromboembolism. (Level of Evidence: B)

Class IIa
1. Antiarrhythmic medications can be useful to prevent recurrent AF 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)}}

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Guideline Resources

 * ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation


 * 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation


 * ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter