Evidence that pharmacological strategies lack efficacy for the prevention of sudden death in hypertrophic cardiomyopathy

Abstract

Medical treatment is not absolutely protective against the risk of sudden death in HCM. The present data inferentially support the use of the implantable defibrillator as the primary treatment choice for prevention of sudden death in high-risk patients with HCM.

Contemporary Insights and Strategies for Risk Stratification and Prevention of Sudden Death in Hypertrophic Cardiomyopathy

“…27 However, pharmacological strategies, popular in the pre-ICD era, failed to achieve absolute protection from SD or from ventricular tachyarrhythmias triggering appropriate ICD interventions, and are now regarded as obsolete. 28 …”

2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

“…Nie przeprowadzono randomizowanych prób klinicznych dotyczących stosowania leków antyarytmicznych w HCM. Amiodaron zmniejsza, być może, częstość występowania SCD u pacjentów z NSVT podczas ambulatoryjnego monitorowania EKG, ale w wielu badaniach nie zapobiegał SCD [380,381]. Dizopiramid i beta-adrenolityki stosuje się w leczeniu zawężenia w LVOT, ale nie ma dowodów, że te leki obniżają ryzyko SCD [116].…”

Hypertrophic cardiomyopathy in children

“…They should also be considered for implantable cardiac defibrillator (ICD) placement to reduce the risk of sudden cardiac death. In a study of 173 patients who were taking amiodarone, beta-blockers, verapamil, or sotalol for treatment of symptoms, there was no difference in sudden death mortality compared with patients who were receiving no pharmacologic therapy (18). Thus, ICD placement remains the primary therapy for prevention of sudden death in highrisk HCM patients.…”