Subclinical AF occurred in 15% of 4,525 HCM patients and 25-30% of cardiac amyloidosis patients; anticoagulation reduced stroke risk from 7% to 1% in HCM.
What is the prevalence and clinical impact of subclinical atrial fibrillation in patients with hypertrophic cardiomyopathy and cardiac amyloidosis?
Subclinical atrial fibrillation is prevalent in 15% of HCM and 25-30% of CA patients, and its detection and subsequent anticoagulation significantly reduce stroke risk.
Absolute Event Rate: 0% vs 0%
Abstract Background Subclinical atrial fibrillation (SCAF) is characterized by asymptomatic episodes of atrial fibrillation (AF), atrial flutter, or atrial tachycardia detected through continuous monitoring but undiagnosed by conventional methods. It is particularly relevant in patients with hypertrophic cardiomyopathy (HCM) and cardiac amyloidosis (CA), who are at increased risk of thromboembolic events. Despite its clinical significance, SCAF detection and management remain suboptimal, and its role in guiding anticoagulation therapy is still debated (Figure 1). Objective This systematic review evaluates the prevalence, clinical impact, and management of SCAF in patients with HCM and CA, with a focus on implantable cardiac devices and wearable technologies for arrhythmia detection. Methods A comprehensive search of PubMed and Scopus was conducted to identify studies on SCAF detection, clinical outcomes, and anticoagulation strategies in patients with HCM and CA. Studies evaluating wearable devices for AF detection in these populations were also reviewed. Results Among 4,525 HCM patients, SCAF was found in 15%, and 17% experienced inappropriate implantable cardioverter defibrillator (ICD) shocks due to AF misclassification, particularly with subcutaneous-ICD (s-ICD) (Figure 2). Anticoagulation reduced stroke risk from 7% to 1%. In CA, 25-30% of patients had SCAF, often detected incidentally. Wearable devices remain underutilized, and no studies have assessed their accuracy in HCM or CA. Conclusion SCAF is underdiagnosed but clinically relevant in HCM and CA, necessitating better screening and anticoagulation strategies. While dual-chamber transvenous-ICDs (tv-ICD) outperform s-ICDs, the role of wearable technologies remains unexplored. Future research should clarify SCAF management guidelines and the clinical value of wearable monitoring in these populations.Figure 1 Figure 2
Napoli et al. (Sat,) reported a other. Subclinical AF occurred in 15% of 4,525 HCM patients and 25-30% of cardiac amyloidosis patients; anticoagulation reduced stroke risk from 7% to 1% in HCM.