From atrial fibrillation management to atrial myopathy assessment: the evolving concept of left atrium disease in hypertrophic cardiomyopathy

: Hypertrophic cardiomyopathy (HCM) is the most prevalent genetically inherited cardiovascular disorder in adults and a significant cause of heart failure and sudden cardiac death. Historically, atrial fibrillation (AF) has been considered a critical aspect in HCM patients as it is considered a marker of disease progression, escalates the frequency of heart failure hospitalizations, increases the risk of thromboembolic events and worsens quality of life and outcome. Increasing evidence suggests that AF is the result of a subtle, long-standing process which starts early in the history of HCM. The process of left atrial dilatation accompanied by morpho/functional remodeling, is the quintessential prerequisite for the onset of AF. This review aims to describe the current understanding of AF pathophysiology in HCM, emphasizing the role of left atrial myopathy in its development. Additionally, we discuss risk factors and management strategies specific to AF in the context of HCM, providing insights into the complexities and challenges of treating such specific patient population.