title: Prognostic difference between paroxysmal and non-paroxysmal atrial fibrillation in patients with hypertrophic cardiomyopathy.
abstract: BACKGROUND
  The association of atrial fibrillation (AF) with sudden death and the difference in prognostic significance between paroxysmal and non-paroxysmal AF remains unclear in patients with hypertrophic cardiomyopathy (HCM). Our aim was to investigate the clinical significance of AF, and to assess the prognostic difference between paroxysmal and non-paroxysmal AF in HCM patients.
  
  
  METHODS
  The study included 430 HCM patients. Documentation of AF was based on electrocardiograms obtained either after the acute onset of symptoms or fortuitously during routine examination of asymptomatic patients.
  
  
  RESULTS
  AF was detected in 120 patients (27.9%). In the patients with AF, syncope and non-sustained ventricular tachycardia were more frequent and the left atrial dimension was larger. Multivariate analysis showed that AF was an independent determinant of the outcome, including the risk of HCM-related death (adjusted hazard ratio 3.57, p<0.001) and sudden death (adjusted hazard ratio 2.61, p=0.038). When patients with AF were divided into subgroups with paroxysmal AF (n=75) or non-paroxysmal AF (n=45), only paroxysmal AF was identified as an independent determinant of the outcome, including the risk of HCM-related death (adjusted hazard ratio 5.24, p<0.001) and sudden death (adjusted hazard ratio 4.67, p=0.002).
  
  
  CONCLUSIONS
  AF is a common supraventricular arrhythmia in HCM and has an adverse influence on the prognosis. In addition, each type of AF had a different clinical impact, with paroxysmal AF being a significant independent determinant of an adverse outcome, including sudden death.
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Bun
authors.initials: B
authors.lastname: Yashiro
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan. Electronic address: yuichiro24@celery.ocn.ne.jp.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Minami
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Terajima
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Hagiwara
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000145:classification / Q000150:complications* / Q000175:diagnosis; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications*; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012306:Risk; D013575:Syncope / Q000209:etiology; D017180:Tachycardia, Ventricular / Q000209:etiology; D013997:Time Factors
keywords: Atrial fibrillation; Cardiomyopathies; Hypertrophic; Prognosis; Sudden death