Showing papers by "Oliver P Guttmann published in 2013"

Systematic review of atrial fibrillation and stroke in patients with hypertrophic cardiomyopathy

Abstract: Background: Hypertrophic Cardiomyopathy (HCM) is a common inherited myocardial disease associated with atrial arrhythmia. Current guidelines for the management of Atrial Fibrillation (AF) do not give detailed advice on management in HCM patients because of a lack of robust clinical prediction tools that can estimate risk of developing AF and an absence of adequately powered studies. Objective: To summarise and critically review literature on AF and stroke in HCM patients and to perform a meta-analysis to determine clinical risk factors for AF and stroke. Data sources: PubMed and Web-of-Science and reference lists of related articles. Study selection: Published articles on clinical studies addressing the topic of HCM, AF and stroke in human subjects. Data extraction: 2 investigators independently extracted data from identified articles. Studies in English language investigating AF and stroke in HCM as primary or secondary endpoint were included. Reviews, case reports, abstracts were excluded. Data synthesis: A random effect meta-regression model was used to determine the pooled overall prevalence and incidence of AF and stroke. The I2 statistic was used to estimate the proportion of total variability in the data attributed to the heterogeneity between the studies. Results: In a total population of 5397 patients in 29 retrospective studies, the overall prevalence of AF was 21.61% (95% CI 19.30-23.92, I2=67.3%, p<0.01). The overall prevalence of thromboembolism in HCM patients with AF was 30.65% (95% CI 23.35-37.95, I2=85%, p<0.01). The overall incidence of AF was 2.99% (95% CI 2.48-3.50, I2=75.4% (p<0.01). The overall incidence of all thromboembolic complications in HCM patients with AF was 4.35% (95% CI 2.91-5.79, I2=62.4%, p<0.05). LA size and age were predictive for the development of AF and stroke in the majority of studies. Meta-analysis revealed an LA diameter of 38.03 mm (95% CI 34.62-41.44) in SR patients and 45.37 mm (95% CI 41.64-49.04) in AF patients. There were no randomized controlled trials of therapy; anticoagulation was associated with a lower incidence of stroke in a small number of studies, but data on the effects of pharmacological therapy and radiofrequency ablation were limited and contradictory. Conclusions: AF is common in HCM and associated with a high risk of thromboembolism. LA size and age are independently associated with AF, but the published literature is insufficient to create a robust tool for the prediction of AF or thromboembolic risk in patients in SR. There are no trials of therapy, but most data suggest that once patients have AF, they should be anticoagulated.