Hello, Let s individually address the problem. 1) in hypertrophic cardiomyopathy, the angina is due to increased muscle mass leading to imbalance in oxygen demand and supply. Secondly due to continued existing coronary artery disease. So here increase dose of beta blocker to max tolerating dose (would help in AF as well), add diisopyramide after beta blockers If you are above 40 check for coronary artery disease and treat like wise 2) about atrial fibrillation. You are on rivoraxabn for anti coagulation so a blood clot doesn t form in the heart. However you may be put on alternative meds for that and a coin machine ( a cardiovertar / defibrillator) to prevent sudden cardiac death can be planned, no need to wait for 2 years for the same. 3) the heart surgery depends on the gradient, also atrial fibrillation may persist even after surgery, more likely if left atrial volume is increased If you can send me all the reports and meds you are taking, I would be able to help you further Regards Dr Priyank Mody