Hypertrophic Cardiomyopathy, Sudden Death, and Implantable Cardiac Defibrillators

Device complications and inappropriate implantable cardioverter defibrillator shocks in patients with hypertrophic cardiomyopathy

“…Although the mortality benefit of ICD implantation in high-risk HCM patients is proven, our study reinforces the notion that ICD therapy, although potentially life-saving, is not benign 21 22. Since current methods of risk stratification are imperfect, the decision to implant an ICD in a young patient with HCM should be undertaken with caution and careful discussion of potential complications.…”

Paced ventricular electrogram fractionation predicts sudden cardiac death in hypertrophic cardiomyopathy

“…Accordingly, application of current non-invasive strategies in this highly representative HCM population would lead to substantial ICD over-implantation, increasing the numbers needed to treat to save one life. 2,5,35 The PPV of fractionation is at least 0.19 and although this is admittedly also a modest value, it is an improvement on a PPV of about 0.1. If ICDs were implanted on a purely algorithmic basis, this improvement would halve the number of implantations resulting in considerable clinical benefit.…”

Outcome of Patients With Hypertrophic Cardiomyopathy and a Normal Electrocardiogram

“…Appropriate discharges from implantable defibrillators for ventricular fibrillation or sustained ventricular tachycardia were regarded as sudden deaths. Invasive septal therapy was offered to patients with significant outflow tract obstruction who remained symptomatic despite appropriate pharmacologic therapy (10,11). The choice of pursuing implantable cardioverter-defibrillator insertion was made on an individual patient basis, taking into consideration the presence of 1 or more risk factors for sudden cardiac death (12), following a comprehensive discussion of the risks and benefits of this particular risk management strategy.…”