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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
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Distinct mechanistic features of atrial fibrillation in hypertrophic cardiomyopathy

Michael Liu1, Sarah Huang1, Masataka Kawana1

  • 1Stanford Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California.

Heart Rhythm
|April 9, 2026
PubMed

Insights

Atrial fibrillation in hypertrophic cardiomyopathy (AF-HCM) presents unique challenges with early onset and poor outcomes. New disease-specific therapies are crucial for managing this complex inherited arrhythmia.

Area of Science:

  • Cardiology
  • Genetics
  • Arrhythmology

Background:

  • Atrial fibrillation in hypertrophic cardiomyopathy (AF-HCM) is a distinct clinical entity.
  • It is characterized by early onset, high prevalence, and poor outcomes compared to general AF.
  • AF-HCM poses a significantly increased risk of stroke and heart failure.

Purpose of the Study:

  • To review the genetic, molecular, and hemodynamic mechanisms underlying AF-HCM.
  • To highlight the limitations of current therapies for AF-HCM.
  • To emphasize the need for novel, disease-specific therapeutic strategies.

Main Methods:

  • Literature review of emerging evidence.
  • Synthesis of data from clinical trials and real-world studies.
  • Analysis of genetic, molecular, and hemodynamic factors.

Main Results:

  • AF-HCM patients have a dramatically increased risk of stroke and heart failure, independent of conventional risk stratification.
  • Current therapies like cardiac ablation and antiarrhythmic drugs show limited efficacy and/or safety.
  • Persistent AF incidence is observed despite advances in HCM management.

Conclusions:

  • AF-HCM requires universal anticoagulation and aggressive rhythm control.
  • Novel, disease-specific therapeutic strategies are urgently needed for AF-HCM.
  • AF-HCM underscores the importance of genotype-driven precision medicine and identifies treatment gaps in inherited arrhythmias.

Keywords:
Antiarrhythmic drugsAtrial fibrillationGeneticsHypertrophic cardiomyopathyInherited arrhythmiasMolecular mechanism

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