PMID- 27794017 OWN - NLM STAT- MEDLINE DCOM- 20170724 LR - 20220408 IS - 1468-201X (Electronic) IS - 1355-6037 (Linking) VI - 103 IP - 9 DP - 2017 May TI - Predictors of atrial fibrillation in hypertrophic cardiomyopathy. PG - 672-678 LID - 10.1136/heartjnl-2016-309672 [doi] AB - OBJECTIVES: Atrial fibrillation (AF) is associated with increased morbidity and mortality in patients with hypertrophic cardiomyopathy (HCM). The primary aim of this study (HCM Risk-AF) was to determine the predictors of AF in a large multicentre cohort of patients with HCM. Exploratory analyses were performed to investigate the association between AF and survival and the efficacy of antiarrhythmic therapy in maintaining sinus rhythm (SR). METHODS: A retrospective, longitudinal cohort of patients recruited between 1986 and 2008 in seven centres was used to develop multivariable Cox regression models fitted with preselected predictors. HCM was defined as unexplained hypertrophy (maximum left ventricular wall thickness of >/=15 mm or in accordance with published criteria for the diagnosis of familial disease). 28% of patients (n=1171) had coexistent hypertension. The primary end point was paroxysmal, permanent or persistent AF detected on ECG, Holter monitoring or implantable device interrogation. RESULTS: Of the 4248 patients with HCM without pre-existing AF, 740 (17.4%) reached the primary end point. Multivariable Cox regression revealed an association between AF and female sex, age, left atrial diameter, New York Heart Association (NYHA) class, hypertension and vascular disease. The proportion of patients with cardiovascular death at 10 years was 4.9% in the SR group and 10.9% in the AF group (difference in proportions=5.9%; 95% CI (4.1% to 7.8%)). The proportion of patients with non-cardiovascular death at 10 years was 3.2% in the SR group and 5.9% in the AF group (difference in proportions=2.8%; 95% CI (0.1% to 4.2%)). An intention-to-treat propensity score analysis demonstrated that beta-blockers, calcium channel antagonists and disopyramide initially maintained SR during follow-up, but their protective effect diminished with time. Amiodarone therapy did not prevent AF during follow-up. CONCLUSION: This study shows that patients with HCM who are at risk of AF development can be identified using readily available clinical parameters. The development of AF is associated with a poor prognosis but there was no evidence that antiarrhythmic therapy prevents AF in the long term. CI - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/. FAU - Guttmann, Oliver P AU - Guttmann OP AD - University College London Institute for Cardiovascular Science and Barts Heart Centre, St. Bartholomew's Hospital, London, UK. FAU - Pavlou, Menelaos AU - Pavlou M AD - Department of Statistical Science, University College London, London, UK. FAU - O'Mahony, Constantinos AU - O'Mahony C AD - University College London Institute for Cardiovascular Science and Barts Heart Centre, St. Bartholomew's Hospital, London, UK. FAU - Monserrat, Lorenzo AU - Monserrat L AD - Cardiology Department and Research Unit, A Coruna University Hospital, Galician Health Service, Spain. FAU - Anastasakis, Aristides AU - Anastasakis A AD - Unit of Inherited Cardiovascular Diseases, First Department of Cardiology, University of Athens, Athens, Greece. FAU - Rapezzi, Claudio AU - Rapezzi C AD - Department of Specialised, Experimental and Diagnostic Medicine, Institute of Cardiology, University of Bologna, Bologna, Italy. FAU - Biagini, Elena AU - Biagini E AD - Department of Specialised, Experimental and Diagnostic Medicine, Institute of Cardiology, University of Bologna, Bologna, Italy. FAU - Gimeno, Juan Ramon AU - Gimeno JR AD - Cardiac Department, University Hospital Virgen ArrixacaMurcia, Spain. FAU - Limongelli, Giuseppe AU - Limongelli G AD - Monaldi Hospital, Second University of Naples, Naples, Italy. FAU - Garcia-Pavia, Pablo AU - Garcia-Pavia P AD - Heart Failure and Inherited Cardiac Diseases Unit, Hospital Universitario Puerta del Hierro Majadahonda, Madrid, Spain. FAU - McKenna, William J AU - McKenna WJ AD - University College London Institute for Cardiovascular Science and Barts Heart Centre, St. Bartholomew's Hospital, London, UK. FAU - Omar, Rumana Z AU - Omar RZ AD - Department of Statistical Science, University College London, London, UK. AD - Biostatistics Group, University College London Hospitals/University College London Clinical Research Centre, University College London, London, UK. FAU - Elliott, Perry M AU - Elliott PM AUID- ORCID: 0000-0003-3383-3984 AD - University College London Institute for Cardiovascular Science and Barts Heart Centre, St. Bartholomew's Hospital, London, UK. CN - Hypertrophic Cardiomyopathy Outcomes Investigators LA - eng GR - FS/12/86/29841/BHF_/British Heart Foundation/United Kingdom PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't DEP - 20161028 PL - England TA - Heart JT - Heart (British Cardiac Society) JID - 9602087 RN - 0 (Anti-Arrhythmia Agents) SB - IM MH - Action Potentials MH - Adult MH - Aged MH - Anti-Arrhythmia Agents/therapeutic use MH - Atrial Fibrillation/*epidemiology/mortality/physiopathology/prevention & control MH - Cardiomyopathy, Hypertrophic/drug therapy/*epidemiology/mortality/physiopathology MH - Electrocardiography, Ambulatory MH - Europe/epidemiology MH - Female MH - Heart Conduction System/drug effects/*physiopathology MH - *Heart Rate/drug effects MH - Humans MH - Incidence MH - Kaplan-Meier Estimate MH - Longitudinal Studies MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Prevalence MH - Propensity Score MH - Proportional Hazards Models MH - Protective Factors MH - Retrospective Studies MH - Risk Assessment MH - Risk Factors MH - Treatment Outcome FIR - Tome-Esteban, Maite IR - Tome-Esteban M FIR - Pantazis, Antonis IR - Pantazis A FIR - Dickie, Shaughan IR - Dickie S FIR - Fernandez, Xusto IR - Fernandez X FIR - Lopez, Angela IR - Lopez A FIR - Vlagkouli, Vasiliki IR - Vlagkouli V FIR - Romero, Antonio IR - Romero A FIR - Buono, Andrea IR - Buono A FIR - Pacileo, Giuseppe IR - Pacileo G FIR - Gallego-Delgado, Maria IR - Gallego-Delgado M FIR - Cobo-Marcos, Marta IR - Cobo-Marcos M EDAT- 2016/11/01 06:00 MHDA- 2017/07/25 06:00 CRDT- 2016/11/01 06:00 PHST- 2016/03/22 00:00 [received] PHST- 2016/09/05 00:00 [revised] PHST- 2016/10/03 00:00 [accepted] PHST- 2016/11/01 06:00 [pubmed] PHST- 2017/07/25 06:00 [medline] PHST- 2016/11/01 06:00 [entrez] AID - heartjnl-2016-309672 [pii] AID - 10.1136/heartjnl-2016-309672 [doi] PST - ppublish SO - Heart. 2017 May;103(9):672-678. doi: 10.1136/heartjnl-2016-309672. Epub 2016 Oct 28.