The HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA.
Circulation. 2017 Dec 19;136(25):2420-2436. doi: 10.1161/CIRCULATIONAHA.117.029267. Epub 2017 Sep 15.
Atrial fibrillation (AF), the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM), is capable of producing symptoms that impact quality of life and is associated with risk for embolic stroke. However, the influence of AF on clinical course and outcome in HCM remains incompletely resolved.
Records of 1558 consecutive patients followed at the Tufts Medical Center Hypertrophic Cardiomyopathy Institute for 4.8±3.4 years (from 2004 to 2014) were accessed.
Of the 1558 patients with HCM, 304 (20%) had episodes of AF, of which 226 (74%) were confined to symptomatic paroxysmal AF (average, 5±5; range, 1 to >20), whereas 78 (26%) developed permanent AF, preceded by 7±6 paroxysmal AF episodes. At last evaluation, 277 patients (91%) are alive at 62±13 years of age, including 89% in New York Heart Association class I or II. No difference was found in outcome measures for patients with AF and age- and sex-matched patients with HCM without AF. Four percent of patients with AF died of HCM-related causes (n=11), with annual mortality 0.7%; mortality directly attributable to AF (thromboembolism without prophylactic anticoagulation) was 0.1% per year (n=2 patients). Patients were treated with antiarrhythmic drugs (most commonly amiodarone [n=103] or sotalol [n=78]) and AF catheter ablation (n=49) or the Maze procedure at surgical myectomy (n=72). Freedom from AF recurrence at 1 year was 44% for ablation patients and 75% with the Maze procedure (<0.001). Embolic events were less common with anticoagulation prophylaxis (4/233, 2%) than without (9/66, 14%) (<0.001).
Transient symptomatic episodes of AF, often responsible for impaired quality of life, are unpredictable in frequency and timing, but amenable to effective contemporary treatments, and infrequently progress to permanent AF. AF is not a major contributor to heart failure morbidity or a cause of arrhythmic sudden death; when treated, it is associated with low disease-related mortality, no different than for patients without AF. AF is an uncommon primary cause of death in HCM virtually limited to embolic stroke, supporting a low threshold for initiating anticoagulation therapy.
心房颤动（AF）是肥厚型心肌病（HCM）中最常见的持续性心律失常，可导致影响生活质量的症状，并与栓塞性卒中风险相关。然而，AF 对 HCM 临床病程和结局的影响仍不完全明确。
本研究纳入了 1558 例连续就诊于塔夫茨医疗中心肥厚型心肌病研究所的患者，随访时间为 4.8±3.4 年（2004 年至 2014 年）。
在 1558 例 HCM 患者中，304 例（20%）发生过 AF，其中 226 例（74%）为症状性阵发性 AF（平均 5±5；范围 1 至>20），78 例（26%）发展为永久性 AF，在此之前发生了 7±6 次阵发性 AF 发作。最后一次评估时，277 例（91%）患者存活，年龄为 62±13 岁，包括 89%的纽约心脏协会心功能分级 I 或 II 级。有 AF 的患者与年龄和性别匹配、无 AF 的 HCM 患者的预后测量指标无差异。4%的 AF 患者因 HCM 相关原因（n=11）死亡，每年死亡率为 0.7%；每年直接归因于 AF（无预防性抗凝的血栓栓塞）的死亡率为 0.1%（n=2 例）。AF 患者接受了抗心律失常药物（最常见的是胺碘酮[n=103]或索他洛尔[n=78]）、AF 导管消融（n=49）或外科心肌切除术的迷宫手术（n=72）。消融患者的 1 年无 AF 复发率为 44%，迷宫手术为 75%（<0.001）。与未接受抗凝预防治疗的患者（9/66，14%）相比，接受抗凝预防治疗的患者（4/233，2%）栓塞事件较少（<0.001）。
短暂的症状性阵发性 AF 常导致生活质量受损，其发作频率和时间不可预测，但可通过有效的现代治疗方法得到有效控制，且很少进展为永久性 AF。AF 不是心力衰竭发病率或心律失常性猝死的主要原因；当得到治疗时，与无 AF 的患者相比，其相关疾病死亡率没有差异。在 HCM 中，AF 实际上很少作为原发性死亡原因，几乎仅限于栓塞性卒中，支持启动抗凝治疗的门槛较低。
