Distinct mechanistic features of atrial fibrillation in hypertrophic cardiomyopathy.

Atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) is increasingly recognized as a distinct clinical entity, characterized by early onset, high prevalence, and uniquely poor outcomes compared with AF in the general population. This review synthesized emerging evidence on the genetic, molecular, and hemodynamic mechanisms underlying AF-HCM. Patients with AF-HCM face a dramatically increased risk of stroke and heart failure, independent of conventional risk stratification tools, necessitating universal anticoagulation and aggressive rhythm control. Current therapies including cardiac ablation and antiarrhythmic drugs demonstrate limited efficacy and/or safety in this population. Recent clinical trials and real-world studies reveal persistent AF incidence despite advances in HCM management, underscoring the need for novel, disease-specific therapeutic strategies. AF-HCM exemplifies the importance of genotype-driven precision medicine in cardiology and highlights ongoing gaps in the treatment of complex inherited arrhythmias.