ObjectiveTo systematically evaluate the prognostic impact of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM).MethodsThe Chinese and English databases (PubMed, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure, and Wanfang database were systematically searched to include observational studies on the prognosis of AF in cardiovascular events or death in patients with HCM; these were evaluated using Revman 5.3.ResultsAfter systematic search and screening, a total of 11 studies with a high study quality were included in this study. Meta-analysis showed that patients with HCM accompanied by AF had a higher risk of all-cause death (odds ratio [OR] = 2.75; 95% confidence interval [CI]: 2.18–3.47;P< 0.001), heart-related death (OR = 2.62; 95%CI: 2.02–3.40;P< 0.001), sudden cardiac death (OR = 7.09; 95%CI: 5.77–8.70;P< 0.001), heart-failure-related death (OR = 2.04; 95%CI: 1.24–3.36;P= 0.005), and stroke death (OR = 17.05; 95%CI: 6.99–41.58;P< 0.001) compared with patients with HCM without AF.ConclusionAtrial fibrillation is a risk factor for adverse survival outcomes in patients with HCM, and aggressive interventions are needed in this population to avoid the occurrence of adverse outcomes.