Hypertrophic Cardiomyopathy Patients With Paroxysmal Atrial Fibrillation Have a High Burden of Left Atrial Fibrosis by Cardiac Magnetic Resonance Imaging

Sanjay Sivalokanathan, Tarek Zghaib, Gabriela V. Greenland, Nestor Vasquez, Shibani M. Kudchadkar, Effrosyni Kontari, Dai Yin Lu, Ketty Dolores-Cerna, Rob J. van der Geest, Ihab R. Kamel, Jeffrey E. Olgin, Theodore P. Abraham, Saman Nazarian, Stefan L. Zimmerman, Roselle Abraham

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Objectives: This study hypothesized that paroxysmal atrial fibrillation (PAF) reflects the presence of a more severe cardiac hypertrophic cardiomyopathy (HCM) phenotype. Background: HCM is characterized by myocyte hypertrophy, fibrosis, and a high prevalence of PAF. It is currently unresolved whether atrial fibrillation (AF) is a marker or a mediator of adverse outcomes in HCM. Methods: This study retrospectively examined 45 HCM patients who underwent cardiovascular magnetic resonance (CMR) imaging in sinus rhythm. The function of all 4 cardiac chambers was assessed, as well as late gadolinium enhancement (LGE) in the left atrium (LA) and left ventricle (LV), as indicators of fibrosis. A fat-saturated, 3-dimensional inversion recovery–prepared, fast-spoiled, gradient-recalled echo sequence, and the image intensity ratio method were used to measure LA-LGE; LGE in the LV was quantified using a semi-automated threshold technique. Results: HCM patients (n = 45) were divided into 2 groups (PAF, no AF) based on history of PAF. All HCM patients had LGE in the LA posterior wall. The PAF group (n = 18) had higher LA volume, a lower LA ejection fraction, a lower global peak longitudinal LA strain (PLAS), and a higher amount of LA-LGE compared with the no AF group (n = 27). A modest inverse association was noted between the LA ejection fraction, PLAS, and LA-LGE; a positive association was present between LV-LGE and LA-LGE. The PAF group had lower ejection fractions in the LV, right atrium, and right ventricle compared with those in the no AF group. Conclusions: PAF is associated with a greater degree of structural LA remodeling and global myopathy, which suggests a more severe cardiac HCM phenotype.

Original languageEnglish (US)
Pages (from-to)364-375
Number of pages12
JournalJACC: Clinical Electrophysiology
Issue number3
StatePublished - Mar 2019


  • cardiovascular magnetic resonance imaging
  • hypertrophic cardiomyopathy
  • late gadolinium enhancement in the left atrium
  • paroxysmal atrial fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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