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Atrial fibrillation in hypertrophic cardiomyopathy: A unique clinical entity requiring dedicated study

Ethan J Rowin1, Konstantinos C Siontis2, Anjali Owens3

  • 1Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts.

Heart Rhythm
|April 9, 2026
PubMed

Insights

Atrial fibrillation in hypertrophic cardiomyopathy (HCM-AF) is a distinct condition. Current therapies for non-HCM atrial fibrillation (AF) show limited success in HCM-AF patients, necessitating dedicated research.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Genetics

Background:

  • Atrial fibrillation (AF) is common in hypertrophic cardiomyopathy (HCM), affecting 20-25% of patients.
  • HCM-AF is linked to increased stroke risk and heart failure.
  • Disease-specific mechanisms in HCM-AF include atrial remodeling and dysfunction, creating an atrial myopathy.

Purpose of the Study:

  • To establish atrial fibrillation in hypertrophic cardiomyopathy (HCM-AF) as a distinct clinical entity.
  • To highlight knowledge and care gaps in managing HCM-AF.
  • To emphasize the need for dedicated research into HCM-AF therapeutics.

Main Methods:

  • Review of current literature on AF in HCM.
  • Analysis of disease-specific mechanisms differentiating HCM-AF from non-HCM AF.
  • Comparison of therapeutic outcomes between HCM-AF and non-HCM AF populations.

Main Results:

  • HCM-AF arises from unique pathophysiological processes distinct from non-HCM AF.
  • Contemporary AF therapies yield poorer outcomes in HCM-AF compared to non-HCM AF.
  • Lower success rates for rhythm control via catheter ablation and antiarrhythmic drugs in HCM-AF.

Conclusions:

  • HCM-AF is a unique clinical entity requiring specialized investigation.
  • Current therapeutic strategies for AF may not be directly transferable to HCM-AF patients.
  • Further research is crucial to develop effective treatments for HCM-AF.

Keywords:
Antiarrhythmic medicationsAtrial fibrillationAtrial fibrillation ablationHypertrophic cardiomyopathyStrokeUnmet need

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