4
Key Points
8. Patients with HCM and persistent or paroxysmal atrial
fibrillation have a sufficiently increased risk of stroke such that
oral anticoagulation with direct-acting oral anticoagulants (or
alternatively warfarin) should be considered the default treatment
option irrespective of the CHA
2
DS
2
-VASc score. New tools to stratify
risk for incident atrial fibrillation have been developed and may
assist in determining the frequency of screening patients with
ambulatory telemetry. Because rapid atrial fibrillation is often poorly
tolerated in patients with HCM, maintenance of sinus rhythm and
rate control are key treatment goals.
9. Exercise stress testing is particularly helpful in determining overall
exercise tolerance and for latent exercise provoked left ventricular
outflow tract obstruction. Because children may not describe
symptoms readily, routine exercise testing can be particularly
important for young patients.
10. Increasingly, data affirm that the beneficial effects of exercise
on general health are extended to patients with HCM. Healthy
recreational exercise (light [<3 metabolic equivalents], moderate
[3–6 metabolic equivalents], and vigorous [>6 metabolic equivalents]
intensity levels) has not been associated with increased risk of
ventricular arrhythmia events in short-term studies. If patients
pursue rigorous exercise training for the purpose of performance
or competition, it is important to engage in a comprehensive
discussion and seek input from expert HCM professionals regarding
the potential risks and benefits, to develop an individualized training
plan, and to establish a regular schedule for reevaluation.
Top 10 Take-Home Messages (cont'd)
