New Insights in the Diagnosis and Treatment of Atrial Fibrillation in Patients with Hypertrophic Obstructive Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is the most common genetic disease in the general population, with a variable phenotypic expression and symptomatology. Atrial fibrillation (AF) is the most common arrhythmia identified among patients diagnosed with HCM. Treatment of both AF and HCM has continuously evolved over time, leading to a significant improvement in the prognosis and life expectancy of symptomatic patients. Numerous studies have demonstrated that the risk of developing this arrhythmia correlates with atrial morphological, functional and electrical remodeling, a process known as atrial myopathy. Once a first episode of AF is diagnosed, permanent anticoagulation is required among patients diagnosed with HCM, regardless of the CHA2 DS2-VA score. Additionally, atrial cardiomyopathy is associated with an increased thromboembolic risk, independent of AF presence, in patients with stable sinus rhythm, in the context of atrial mechanical and endothelial dysfunction. This article aims to evaluate the current scientific evidence and treatment approaches in patients diagnosed with HCM.