title: Atrial fibrillation in hypertrophic cardiomyopathy: A turning point towards increased morbidity and mortality.
abstract: BACKGROUND
  Atrial fibrillation (AF) is the most common arrhythmic event in patients with hypertrophic cardiomyopathy (HCM). The aim of this study was to identify the clinical impact and prognostic significance of AF on a large cohort of patients with HCM.
  
  
  METHODS
  Echocardiographic and clinical correlates, risk factors for AF and thromboembolic stroke and the prognostic significance of AF were evaluated in 509 patients with an established diagnosis of HCM.
  
  
  RESULTS
  A total of 119 patients (23.4%) were diagnosed with AF during the index evaluation visit. AF patients had a higher prevalence of stroke and presented with worse functional impairment. Left atrial diameter (LA size) was a common independent predictor of the arrhythmia (OR: 2.2, 95% CI 1.6-3.3) and thromboembolic stroke (OR: 1.6, 95% CI 1.01-2.40). AF was an important risk factor for overall mortality (HR=3.4, 95% CI: 1.7-6.5), HCM-related mortality (HR=3.9, 95% CI: 1.8-8.2) and heart failure-related mortality (HR=6.0, 95% CI: 2.0-17.9), even after adjusting for statistically significant clinical and demographic risk factors. However, AF did not affect the risk for sudden death.
  
  
  CONCLUSIONS
  LA size is an independent predictor of both AF and thromboembolic stroke. Moreover, patients with AF, regardless of type, have significantly higher mortality rates than patients without AF.
authors.affiliation: 1(st) Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. Electronic address: zegkosth@gmail.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zegkos
authors.affiliation: 1(st) Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Georgios K
authors.initials: GK
authors.lastname: Efthimiadis
authors.affiliation: 1(st) Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Despoina G
authors.initials: DG
authors.lastname: Parcharidou
authors.affiliation: 1(st) Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Gossios
authors.affiliation: 1(st) Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Giannakoulas
authors.affiliation: 1(st) Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Ntelios
authors.affiliation: 1(st) Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Antonis
authors.initials: A
authors.lastname: Ziakas
authors.affiliation: 1(st) Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Stelios
authors.initials: S
authors.lastname: Paraskevaidis
authors.affiliation: 1(st) Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Haralambos I
authors.initials: HI
authors.lastname: Karvounis
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D002423:Cause of Death / Q000639:trends; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006115:Greece / Q000453:epidemiology; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: atrial fibrillation; hypertrophic cardiomyopathy; left atrium; morbidity; mortality