36
Treatment
8.4. Management of Patients With HCM and AF
COR LOE
Recommendations
1 B-NR
1. In patients with HCM and clinical AF, anticoagulation
is recommended with DOACs as first-line option and
vitamin K antagonists as second-line option, independent of
CHA
2
DS
2
-VASc score.
1 C-LD
2. In patients with HCM and subclinical AF detected by
internal or external cardiac device or monitor of >24 hours'
duration for a given episode, anticoagulation is recommended
with DOACs as first-line option and vitamin K antagonists
as second-line option, independent of CHA
2
DS
2
-VASc score.
1 C-LD
3. In patients with AF in whom rate control strateg y is
planned, either beta blockers, verapamil, or diltiazem are
recommended, with the choice of agents according to patient
preferences and comorbid conditions.
2a C-LD
4. In patients with HCM and subclinical AF detected by
internal or external device or monitor, of >5 minutes'
duration but <24 hours' duration for a given episode,
anticoagulation with DOACs as first-line option and vitamin
K antagonists as second-line option can be beneficial, taking
into consideration duration of AF episodes, total AF burden,
underlying risk factors, and bleeding risk.
2a B-NR
5. In patients with HCM and poorly tolerated AF, a rhythm-
control strateg y with cardioversion or antiarrhythmic drugs
can be beneficial with the choice of an agent according to
AF symptom severity, patient preferences, and comorbid
conditions.
2a B-NR
6. In patients with HCM and symptomatic AF, as part of an
AF rhythm-control strateg y, catheter ablation for AF can be
effective when drug therapy is ineffective, contraindicated, or
not the patient's preference.
2a B-NR
7. In patients with HCM and AF who require surgical
myectomy, concomitant surgical AF ablation procedure can
be beneficial for AF rhythm control.
