Cardiac myosin inhibitors are not associated with an increased risk of incident atrial fibrillation in hypertrophic cardiomyopathy based on current randomized evidence.
Do cardiac myosin inhibitors increase the risk of incident atrial fibrillation in patients with hypertrophic cardiomyopathy?
Current randomized evidence does not show an increased risk of incident atrial fibrillation with cardiac myosin inhibitors in hypertrophic cardiomyopathy, though real-world longitudinal monitoring remains necessary.
Randomized evidence to date does not demonstrate an increased AF risk with CMIs. Differences between RCT populations and real-world cohorts, including restrictive AF eligibility criteria, lower baseline atrial remodeling, and limited rhythm surveillance may explain discordant observational findings and highlight the need for longitudinal monitoring in clinical practice.
Karakasis et al. (2026) studied this question. Cardiac myosin inhibitors are not associated with an increased risk of incident atrial fibrillation in hypertrophic cardiomyopathy based on current randomized evidence.