Prevalent electrocardiographic pattern in patients with hypertrophic cardiomyopathy and atrial arrhythmias other than atrial fibrillation

Abstract

Introduction: Electrocardiographic tracing plays an important role in the diagnosis and prognostic stratification of patients with Hypertrophic Cardiomyopathy (HCM).  Objectives: To determine the electrocardiographic signs present in these patients and their correlation with the prevalence of isolated atrial arrhythmias and self-limited bursts that could create a predictive pattern of Atrial Fibrillation. Material and methods: Observational, descriptive, cross-sectional, and statistical correlation study of Spanish and Argentine patients with HCM in whom anamnesis, physical examination, electrocardiogram, transthoracic Doppler echocardiogram and Holter study were performed. Results: There were 117 patients included, mean age 47 years, 56% male. The prevalence of isolated premature atrial contractions (PACs) was 79.8%, high density of PACs 14.9%, atrial couplets 47.3%, self-limited atrial salvoes 38.9%, atrial flutter 4.7%, and atrial arrhythmias other than atrial fibrillation (AAOAF) 57.7%. The electrocardiographic signs that were statistically correlated with the presence of AAOAF were P wave ≥100 ms, P wave dispersion <40 ms, QRS duration >80 ms, the presence of high density of isolated premature ventricular contractions (PVCs) and non-sustained ventricular tachycardia salvoes in Holter study. The presence of pathological Q waves showed just a statistical trend. Conclusions: In patients with HCM, AAOAF showed a high prevalence and were associated with an electrocardiographic pattern composed of P wave ≥100 ms, P dispersion <40 ms, QRS >80 ms, PVCs >10/hour, NSVT. This pattern could be associated with the development of AF in patients with HCM.