State-of-the-Art Treatments for Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy
Atrial fibrillation (AF) and hypertrophic cardiomyopathy (HCM) are two very common clinical entities, which often occur simultaneously, giving a hard time to both patients and cardiologists. Myocyte hypertrophy, myocyte disarray and interstitial fibrosis in the left atrium (LA) predisposes to atrial...
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doaj-ffd1054c080549c2be7d33a245618dc52021-07-23T13:47:48ZengMDPI AGJournal of Clinical Medicine2077-03832021-07-01103025302510.3390/jcm10143025State-of-the-Art Treatments for Atrial Fibrillation in Patients with Hypertrophic CardiomyopathyDiego Penela0Antonio Sorgente1Riccardo Cappato2Arrhythmia and Electrophysiology Research Center Gruppo Multimedica, Via Milanese 300, 20099 Sesto San Giovanni, ItalyDepartment of Cardiology, Epicura Hospitalier Centre, 7301 Hornu, BelgiumArrhythmia and Electrophysiology Research Center Gruppo Multimedica, Via Milanese 300, 20099 Sesto San Giovanni, ItalyAtrial fibrillation (AF) and hypertrophic cardiomyopathy (HCM) are two very common clinical entities, which often occur simultaneously, giving a hard time to both patients and cardiologists. Myocyte hypertrophy, myocyte disarray and interstitial fibrosis in the left atrium (LA) predisposes to atrial arrhythmias due to modifications of the substrate that promote re-entry. AF is usually poorly tolerated due to the shortening of the diastolic time with rapid heart rates and the lack of the atrial contribution to the diastolic filling in patients who often have a previous diastolic dysfunction. AF onset frequently results in exercise intolerance and recurrent heart failure admissions and also has prognostic implications. Early maintenance of sinus rhythm appears as a worthy approach in these patients, especially when started early in the course of the disease. However, treatment with antiarrhythmic (AA) agents in HCM patients is less effective than in patients without the disease, and concerns regarding safety frequently limit the long-term adherence. Catheter ablation has limited efficacy in patients with persistent AF but can play an important role in patients with paroxysmal AF, emphasizing the importance of an accurate patient selection. The aim of this review is to provide an overview of the pathophysiology of combined HCM and AF and the principal pharmacological and non-pharmacological treatments recommended in this complex clinical scenario.https://www.mdpi.com/2077-0383/10/14/3025atrial fibrillationhypertrophic cardiomyopathyantiarrhythmic drugscatheter ablationanticoagulation |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Diego Penela Antonio Sorgente Riccardo Cappato |
spellingShingle |
Diego Penela Antonio Sorgente Riccardo Cappato State-of-the-Art Treatments for Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy Journal of Clinical Medicine atrial fibrillation hypertrophic cardiomyopathy antiarrhythmic drugs catheter ablation anticoagulation |
author_facet |
Diego Penela Antonio Sorgente Riccardo Cappato |
author_sort |
Diego Penela |
title |
State-of-the-Art Treatments for Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy |
title_short |
State-of-the-Art Treatments for Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy |
title_full |
State-of-the-Art Treatments for Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy |
title_fullStr |
State-of-the-Art Treatments for Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy |
title_full_unstemmed |
State-of-the-Art Treatments for Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy |
title_sort |
state-of-the-art treatments for atrial fibrillation in patients with hypertrophic cardiomyopathy |
publisher |
MDPI AG |
series |
Journal of Clinical Medicine |
issn |
2077-0383 |
publishDate |
2021-07-01 |
description |
Atrial fibrillation (AF) and hypertrophic cardiomyopathy (HCM) are two very common clinical entities, which often occur simultaneously, giving a hard time to both patients and cardiologists. Myocyte hypertrophy, myocyte disarray and interstitial fibrosis in the left atrium (LA) predisposes to atrial arrhythmias due to modifications of the substrate that promote re-entry. AF is usually poorly tolerated due to the shortening of the diastolic time with rapid heart rates and the lack of the atrial contribution to the diastolic filling in patients who often have a previous diastolic dysfunction. AF onset frequently results in exercise intolerance and recurrent heart failure admissions and also has prognostic implications. Early maintenance of sinus rhythm appears as a worthy approach in these patients, especially when started early in the course of the disease. However, treatment with antiarrhythmic (AA) agents in HCM patients is less effective than in patients without the disease, and concerns regarding safety frequently limit the long-term adherence. Catheter ablation has limited efficacy in patients with persistent AF but can play an important role in patients with paroxysmal AF, emphasizing the importance of an accurate patient selection. The aim of this review is to provide an overview of the pathophysiology of combined HCM and AF and the principal pharmacological and non-pharmacological treatments recommended in this complex clinical scenario. |
topic |
atrial fibrillation hypertrophic cardiomyopathy antiarrhythmic drugs catheter ablation anticoagulation |
url |
https://www.mdpi.com/2077-0383/10/14/3025 |
work_keys_str_mv |
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