Atrial fibrillation hypertrophic cardiomyopathy
Jump to navigation
Jump to search
 |
Resident Survival Guide |
| File:Critical Pathways.gif |
Sinus rhythm  |
Atrial fibrillation  |
|
Atrial Fibrillation Microchapters | |
|
Special Groups | |
|---|---|
|
Diagnosis | |
|
Treatment | |
|
Cardioversion | |
|
Anticoagulation | |
|
Surgery | |
|
Case Studies | |
|
Atrial fibrillation hypertrophic cardiomyopathy On the Web | |
|
Directions to Hospitals Treating Atrial fibrillation hypertrophic cardiomyopathy | |
|
Risk calculators and risk factors for Atrial fibrillation hypertrophic cardiomyopathy | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Anahita Deylamsalehi, M.D.[2] Cafer Zorkun, M.D., Ph.D. [3]; Varun Kumar, M.B.B.S., Dima Nimri, M.D. [4]
Overview
Atrial fibrillation is considered as a common complications of hypertrophic cardiomyopathy. Prevalence of atrial fibrillation among hypertrophic cardiomyopathy patients has been estimated as 20% in a 9 year follow up period. However it's prevalence in patients with hypertrophic cardiomyopathy older than 70 years old is estimated as high as 40%. Hypertrophic cardiomyopathy patients with atrial fibrillation has a worse prognosis, compared to those without atrial fibrillation, even in when risk factors are corrected. Evidences of left atrial dysfunction based on echocardiography and electrocardiogram are associated to atrial fibrillation development in hypertrophic cardiomyopathy patients. Heart failure and mortality as a result of it, stroke and serious functional impairment are some of the consequences of concurrent atrial fibrillation and hypertrophic cardiomyopathy. The medical management of patients with hypertrophic cardiomyopathy involves minimizing diastolic dysfunction, reducing left ventricular outflow tract obstruction, optimizing heart failure management, maintaining sinus rhythm, rate control and anticoagulation in the presence of atrial fibrillation.
Atrial Fibrillation and Hypertrophic Cardiomyopathy
- In patients with hypertrophic cardiomyopathy (HCM), some factors such as, atrial fibrillation, advanced age, hypertension, mitral annular calcification, and left atrial enlargment contribute to systemic embolism.[1][2][3][2][4][1]
- Atrial fibrillation is considered as a common complications of hypertrophic cardiomyopathy.[5][6][7]
- Based on a study the prevalence of atrial fibrillation among hypertrophic cardiomyopathy patients has been estimated as 20% in a 9 year follow up period.[7]
- It has been estimated that the prevalence of atrial fibrillation development in patients with hypertrophic cardiomyopathy older than 70 years old could be as high as 40%. [7][5]
- Atrial fibrillation has been shown to be associated with an increased risk for hypertrophic cardiomyopathy related death (odds ratio 3.7; P<0.002) secondary to excess heart failure-related mortality but it is not associated to sudden cardiac death.[5]
- Hypertrophic cardiomyopathy patients with atrial fibrillation has a worse prognosis, compared to those without atrial fibrillation, even in when risk factors are corrected. [5][8]
- Based on multiple small cohort studies, the following conditions are associated with atrial fibrillation development in hypertrophic cardiomyopathy patients:
- Evidences of left atrial dysfunction based on echocardiography, such as:[9][10]
- Diameter of left atria
- Volume index of left atria
- Fractional shortening
- Evidences of left atrial dysfunction based on electrocardiogram, such as P‐wave dispersion
- Evidences of left atrial dysfunction based on echocardiography, such as:[9][10]
- Atrial fibrillation 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).[7]
- The following conditions are seen more frequently as a result of concurrent atrial fibrillation in hypertrophic cardiomyopathy, singularly in patients who are younger than 50 years old, had a chronic atrial fibrillation or had an outflow obstruction:[7]
- Heart failure and mortality as a result of it
- Stroke
- Serious functional impairment
- Antiarrhythmic agents such as disopyramide, propafenone, and amiodarone may be used to prevent atrial fibrillation episodes and modulate the rate of ventricular response in patients with HCM.[11]
- Based on study done on 4248 patients with hypertrophic cardiomyopathy without previous atrial fibrillation, medications such as beta blockers, calcium channel antagonists and disopyramide were effective in maintaining sinus rhythm at the beginning, however these medications lost their protective effects in the long run. [12]
- The medical management of patients with hypertrophic cardiomyopathy involves minimizing diastolic dysfunction, reducing left ventricular outflow tract obstruction, optimizing heart failure management, maintaining 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.
2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[13]
Hypertrophic Cardiomyopathy (DO NOT EDIT)[13]
| 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[14]
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)[15]
Hypertrophic Cardiomyopathy (DO NOT EDIT) [15]
| 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
- 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation [17]
- ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter [18]
References
- ↑ 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
- ↑ 2.0 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
- ↑ 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
- ↑ Staffurth JS, Gibberd MC, Fui SN (1977) Arterial embolism in thyrotoxicosis with atrial fibrillation. Br Med J 2 (6088):688-90. PMID: 902055
- ↑ 5.0 5.1 5.2 5.3 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.
- ↑ Kubo T, Kitaoka H, Okawa M, Hirota T, Hayato K, Yamasaki N; et al. (2009). "Clinical impact of atrial fibrillation in patients with hypertrophic cardiomyopathy. Results from Kochi RYOMA Study". Circ J. 73 (9): 1599–605. doi:10.1253/circj.cj-09-0140. PMID 19590139.
- ↑ 7.0 7.1 7.2 7.3 7.4 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. doi:10.1161/hc4601.097997. PMID 11714644.
- ↑ Stafford WJ, Trohman RG, Bilsker M, Zaman L, Castellanos A, Myerburg RJ (1986). "Cardiac arrest in an adolescent with atrial fibrillation and hypertrophic cardiomyopathy". J Am Coll Cardiol. 7 (3): 701–4. doi:10.1016/s0735-1097(86)80484-3. PMID 3950248.
- ↑ Ozdemir O, Soylu M, Demir AD, Topaloglu S, Alyan O, Turhan H; et al. (2004). "P-wave durations as a predictor for atrial fibrillation development in patients with hypertrophic cardiomyopathy". Int J Cardiol. 94 (2–3): 163–6. doi:10.1016/j.ijcard.2003.01.001. PMID 15093974.
- ↑ Losi MA, Betocchi S, Aversa M, Lombardi R, Miranda M, D'Alessandro G; et al. (2004). "Determinants of atrial fibrillation development in patients with hypertrophic cardiomyopathy". Am J Cardiol. 94 (7): 895–900. doi:10.1016/j.amjcard.2004.06.024. PMID 15464672.
- ↑ 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
- ↑ Guttmann OP, Pavlou M, O'Mahony C, Monserrat L, Anastasakis A, Rapezzi C; et al. (2017). "Predictors of atrial fibrillation in hypertrophic cardiomyopathy". Heart. 103 (9): 672–678. doi:10.1136/heartjnl-2016-309672. PMID 27794017.
- ↑ 13.0 13.1 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.
- ↑ 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.
- ↑ 15.0 15.1 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.
- ↑ 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
- ↑ 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
- ↑ 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