Atrial fibrillation in patients with left ventricular non-compaction: incidence and associations with stroke, heart failure, and mortality

AIMS: Left ventricular non-compaction (LVNC) is a genetic cardiomyopathy with presentations ranging from asymptomatic disease to heart failure, stroke, and sudden cardiac death. LVNC-related structural and functional abnormalities may increase atrial fibrillation (AF) risk, but data are limited. We assessed AF incidence in LVNC and compared outcomes in patients with versus without AF. METHODS AND RESULTS: Two cohorts of patients were identified using the TriNetX platform: (i) patients with LVNC without a prior history of AF or stroke; and (ii) patients with LVNC and AF without a prior history of stroke. The primary objective was to assess the 3-year risk of a composite of all-cause mortality, stroke, acute myocardial infarction, and heart failure in the two cohorts. Hazard ratios (HRs) were derived from univariable cox proportional models before and after propensity score matching (PSM). Matching was conducted using a greedy nearest-neighbour approach with a caliper of 0.1.Patients with LVNC and AF (N=29,356) were older and exhibited a higher burden of comorbidities compared with LVNC patients without AF (N=39,339). In this observational analysis, after PSM, AF in patients with LVNC was associated with higher risks of stroke (HR 1.466, 95% CI 1.359-1.581), new-onset heart failure (HR 1.439, 95% CI 1.358-1.526), all-cause death (HR 1.255, 95% CI 1.200-1.312), and the composite outcome (HR 1.301, 95% CI 1.269-1.334) compared with LVNC patients without AF. The 1-year incidence of AF in patients with LVNC was 36 per 1000 person-years. CONCLUSION: In this observational cohort, LVNC was associated with a high incidence of AF, and the presence of AF was associated with higher risks of stroke, heart failure, and all-cause death. Further prospective studies are warranted to assess the prognostic impact of AF in patients with LVNC.