Inibitori della miaosina cardiaca e fibrillazione atriale incidente nella cardiomiopatia ipertrofica: revisione sistematica e meta-analisi.

INTRODUCTION: Cardiac myosin inhibitors (CMIs) improve hemodynamics and symptoms in hypertrophic cardiomyopathy (HCM), but recent real-world data have raised concerns regarding an increased risk of atrial fibrillation (AF). We sought to reassess AF risk using randomized controlled trial (RCT) evidence and to contextualize discrepancies with observational reports. METHODS AND RESULTS: We performed a systematic review and random-effects meta-analysis of RCTs evaluating the effect of CMIs on incident AF in HCM. MEDLINE, Scopus, and CENTRAL were searched through November 25, 2025. Eight RCTs (n = 1581) comparing mavacamten or aficamten with placebo or active control were included. Event counts