Active Heart, Stroke & Blood Brain & Nervous System

Atrial electrophysiology in hypertrophic cardiomyopathy

Funder BHF Charity-funded
Recipient organisation King's College London
Funding £293K
Period Jul 2025 — Oct 2027

In plain English

AI plain-English summary

Up to one in five people with hypertrophic cardiomyopathy—a disease that thickens the heart muscle—will develop atrial fibrillation, yet doctors do not understand why the atria in these patients become electrically unstable. Current treatments for atrial fibrillation are based on what happens in structurally normal hearts, but the underlying disease process in hypertrophic cardiomyopathy may change the atria themselves. This project will directly measure the electrical properties and structural abnormalities in the atria of patients with both conditions, then compare them with patients who have atrial fibrillation but normal hearts. The researchers will also link those changes to pressure inside the left atrium and to ventricular abnormalities visible on cardiac MRI. The findings will feed into computer models that simulate how the atria behave electrically and test virtual ablation procedures. If successful, this work could reveal why standard treatments often fail in these patients and point toward therapies tailored to the specific atrial changes caused by hypertrophic cardiomyopathy—potentially reducing the burden of a common, debilitating arrhythmia in a group already at high risk.

View original technical description
Atrial fibrillation (AF) is the most common sustained arrhythmia in patients with hypertrophic cardiomyopathy (HCM), affecting up to 20% of patients. Despite its prevalence, the pathophysiology of AF in patients with HCM is poorly understood. While the diagnosis of HCM hinges on left ventricular hypertrophy (LVH) the histological phenotype is broader and includes ventricular fibrosis and myocyte disarray, contributing to the arrhythmic risk. We postulate that those changes may also affect atrial tissue thereby directly influencing atrial electrophysiology and resulting in increased AF risk. The study aims to characterise the electrophysiological properties and structural changes within the atria of patients with HCM and AF and compare them to those seen in patients with AF and structurally normal hearts. We hypothesise that those changes are a function of both left atrial pressure and hypertrophic cardiomyopathy disease severity. The findings will therefore be correlated with left atrial pressure and changes in the ventricles seen on cardiac MRI. The data will be used to create computational models to simulate changes in electrophysiological properties and ablation procedures. The findings seek to enhance the understanding of the HCM arrhythmia substrate in order to support the future development of improved therapies for AF in HCM.

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Researchers

Mark O'Neill (EPMC Awardee)

Related Research

Grants with similar aims, by meaning.

Human atrial action potential alternans and afterdepolarisations: electrophysiological and calcium-cycling mechanisms and effects of myocardial disease
Predictors of disease progression in hypertrophic cardiomyopathy
A mechanistic exploratory study of AF- induced cardiac dysfunction and symptoms
The interdependence of anatomy and function in atrial fibrillation
Deep structural phenotype of hypertrophic cardiomyopathy; from mutation to hypertrophy (Dr George Joy)

Original classification

None

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