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Background: Atrial fibrillation (AF) increases the risks of stroke and mortality. It remains unclear whether rhythm control reduces the risk of stroke in patients with AF concomitant with hypertrophic cardiomyopathy (HCM)., Methods: We identified AF patients with HCM who were ≥ 18 years old in the Taiwan National Health Insurance Database. Patients using antiarrhythmic medications for ≥ 30 defined daily doses (DDDs) or receiving catheter ablation for AF constituted the rhythm control group. Patients using rate control medications for ≥ 30 DDDs constituted the rate control group. A multivariable Cox regression model was used to evaluate the hazard ratio (HR) for adverse cardiovascular events., Results: We enrolled a total of 178 patients with both AF and HCM without pre-existing cardiovascular diseases. Among them, 99 were in the rhythm control group and 79 were in the rate control group. After a follow-up period of 6.47 ± 0.98 years, the rhythm control group had a lower risk of stroke than the rate control group (adjusted HR: 0.380, p = 0.031) after adjusting for covariates including use of antithrombotic agents. After excluding patients receiving catheter ablation, the rhythm control group still had a lower risk of stroke than the rate control group (adjusted HR: 0.380, p = 0.037)., Conclusions: In patients with AF and HCM, rhythm control with mainly pharmacological treatment better prevented stroke than rate control in long-term follow-up. The beneficial effect of lowering stroke risk through rhythm control was independent of oral anticoagulant use., Competing Interests: All the authors declare no conflict of interest.

Background: The presence of ventricular tachycardia (VT) is associated with higher mortality. The annual incidence of VT after a diagnosis of amyloidosis and the associated cardiovascular (CV) outcomes have not been well assessed in a large cohort., Methods: A total of 12,139 amyloidosis patients were identified from the Taiwan National Health Insurance Research Database. Non-amyloidosis group was matched 1:1 for age, gender, hypertension, and diabetes mellitus (DM) to the amyloidosis group using a propensity score. Analysis of the risk of CV outcomes was conducted. We also analyzed the incidence of cardiac amyloidosis (CA)., Results: The incidence rates of amyloidosis and CA were 6.54 and 0.61 per 100,000 person-years, respectively. Multivariable analysis revealed that the risk of VT was higher in both the amyloidosis [hazard ratio (HR): 7.90; 95% confidence interval (CI): 4.49-13.9] and CA (HR: 153.3, 95% CI: 54.3-432.7) groups. In the amyloidosis group, the risk of heart failure (HF)-related hospitalization, CV death, and all-cause death was also higher. Amyloidosis was associated with a higher CV mortality rate following VT (HR: 1.50; 95% CI: 1.07-2.12). The onset of a new VT event in patients with amyloidosis was associated with HF, DM, chronic liver disease, and anti-arrhythmic drug use., Conclusions: In this nationwide cohort study, the incidence rates of amyloidosis and CA were 6.54 and 0.61 per 100,000 person-years, respectively. The long-term risks of VT and CV mortality were higher in the patients with amyloidosis and CA. The patients with amyloidosis had a poorer prognosis following VT events, highlighting the importance of continuous monitoring in these patients.