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Rhythm Control Better Prevents Stroke than Rate Control in Patients with Concomitant Hypertrophic Cardiomyopathy and

Shang-Ju Wu1,2, Yun-Yu Chen1,3,4, Yu-Shan Chien1,2,5,6

  • 1Cardiovascular Center, Taichung Veterans General Hospital, Taichung.

Acta Cardiologica Sinica
|January 8, 2025
PubMed

Insights

Rhythm control therapy significantly reduced stroke risk in patients with atrial fibrillation (AF) and hypertrophic cardiomyopathy (HCM). This approach, primarily using medication, proved more effective than rate control for stroke prevention in long-term follow-up.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Clinical Research

Background:

  • Atrial fibrillation (AF) is a known risk factor for stroke and mortality.
  • The impact of rhythm control on stroke risk in patients with concomitant hypertrophic cardiomyopathy (HCM) is not well-established.

Purpose of the Study:

  • To investigate whether rhythm control therapy reduces stroke risk in patients diagnosed with both atrial fibrillation and hypertrophic cardiomyopathy.
  • To compare the effectiveness of rhythm control versus rate control strategies in preventing adverse cardiovascular events in this patient population.

Main Methods:

  • A cohort of 178 adult patients with both AF and HCM was identified from the Taiwan National Health Insurance Database.
  • Patients were categorized into rhythm control (antiarrhythmic medications or catheter ablation) or rate control (rate-controlling medications) groups.
  • A multivariable Cox regression model was employed to assess the hazard ratio for adverse cardiovascular events, including stroke.

Main Results:

  • The rhythm control group (99 patients) demonstrated a significantly lower risk of stroke compared to the rate control group (79 patients) over a mean follow-up of 6.47 years (adjusted HR: 0.380, p = 0.031).
  • This stroke risk reduction benefit persisted even after excluding patients who underwent catheter ablation (adjusted HR: 0.380, p = 0.037).
  • The protective effect of rhythm control on stroke risk was independent of oral anticoagulant use.

Conclusions:

  • Rhythm control, primarily through pharmacological means, is more effective than rate control in preventing stroke among patients with both AF and HCM.
  • The findings suggest a long-term benefit of maintaining sinus rhythm in this specific patient cohort.
  • Rhythm control offers a valuable strategy for mitigating stroke risk in patients with AF and HCM, irrespective of antithrombotic therapy.
Abstract

Keywords:
Antiarrhythmic drugsAtrial fibrillationCatheter ablationHypertrophic cardiomyopathyRhythm control

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