Implantable Cardioverter Defibrillator and Hypertrophic Cardiomyopathy. Experience at Three Centers

Marı́n, Francisco; Gimeno, Juan R.; Payá, Eduardo; García‐Alberola, Arcadio; Pérez-Álvarez, Luisa; Fernández, Xusto; Morena, Gonzalo de la; Sogorb, Francisco; Castro‐Beiras, Alfonso; Valdés, Mariano; Martı́nez, Juan Gabriel; Monserrat, Lorenzo

doi:10.1016/s1885-5857(07)60004-8

Cited by 13 publications

(16 citation statements)

References 37 publications

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“…Consistent with the predilection of SCD in young patients with HCM, almost 30% of those receiving ICDs were ≤20 years of age, largely for primary prevention, and they experienced appropriate ICD interventions at an average of 18±4 years of age (ie, 7%/year). Intervention rates in the multicenter study are consistent with those reported individually from other countries, including Spain, 16 Poland, 17,58 Canada, 12 Portugal, 60 United Kingdom, 61 Germany, 59 Australia, 11 Italy 9 and other U.S. centers. 48,62, 63 It is notable that the ICD has performed so reliably in terminating VT/VF in patients with a disease such as HCM, which is associated with unique pathology and hemodynamic features such as a substantial increase in LV mass (wall thickening up to 3-to 5-fold greater than normal), 23,64 dynamic obstruction to LV outflow with elevated intraventricular pressures, 31,34 diastolic dysfunction and microvascular myocardial ischemia due to small vessel disease.…”

Section: Efficacysupporting

confidence: 83%

“…16 However, there is no compelling evidence that paroxysmal AF is a predictor specifically of SCD in cohort analyses, although reported as an occasional trigger for VT. 49 Genotyping It was 20 years ago that there was initial recognition that mutations in genes encoding proteins of the cardiac sarcomere cause HCM, which created substantial enthusiasm for identifying malignant or benign genetic substrates in order to facilitate assignment of SCD risk level. 51 Although now commercially available, genetic testing has not achieved the initial expectation that it would become a reliable strategy for predicting prognosis or selecting patients for primary prevention ICDs.…”

Section: Uncertain Contributors To Riskmentioning

confidence: 99%

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Risk Stratification and Role of Implantable Defibrillators for Prevention of Sudden Death in Patients With Hypertrophic Cardiomyopathy

Maron

2010

Circ J

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Section: Efficacysupporting

confidence: 83%

Section: Uncertain Contributors To Riskmentioning

confidence: 99%

Risk Stratification and Role of Implantable Defibrillators for Prevention of Sudden Death in Patients With Hypertrophic Cardiomyopathy

Maron

2010

Circ J

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“…Hence, the summary estimate of clinical data and outcome is based on 16 studies. 4,7,9,[12][13][14]16,[18][19][20][24][25][26][27][28]30 Thirteen (81%) studies reported on a population of patients with HCM with an ICD for primary or secondary prevention of SCD, 1 (8%) study focused on patients with HCM with an ICD for primary prevention of SCD, and 2 (13%) studies reported on patients with hypertrophic obstructive cardiomyopathy who underwent alcohol septal ablation and had received an ICD.…”

Section: Search Resultsmentioning

confidence: 99%

Outcome and Complications After Implantable Cardioverter Defibrillator Therapy in Hypertrophic Cardiomyopathy

Schinkel

Vriesendorp

Sijbrands

et al. 2012

Circ: Heart Failure

150

125

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P atients with hypertrophic cardiomyopathy (HCM) are at increased risk for sudden cardiac death (SCD), mostly caused by ventricular arrhythmias. SCD may occur as the initial presentation of HCM, often in asymptomatic or mildly symptomatic patients. 1 In fact, HCM is the most frequent cause of SCD in young people, including trained athletes. 2,3 Implantable cardioverter defibrillator (ICD) therapy may effectively terminate potentially life-threatening ventricular arrhythmias, thereby preventing SCD and prolonging life. Still, ICD therapy is not without risk, because inappropriate interventions and device-related complications may occur. Clinical Perspective on p 559Previous observational studies have reported on the use of ICD therapy for primary and secondary preventions of SCD in HCM. A complete overview of outcome and complications after ICD therapy in patients with HCM at risk for SCD is currently not available. The goal of this analysis was to pool the individual studies in an effort to examine the precise rate of cardiac and noncardiac mortality, appropriate and inappropriate interventions, and complications. This knowledge may aid clinical decision making and counseling in patients with HCM at increased risk for SCD considered for ICD therapy. Methods Study DesignThis systematic review and meta-analysis included all available original studies reporting clinical outcome and complications in patients with HCM who underwent ICD implantation. Studies that did not provide data on outcome or complications and review manuscripts were excluded. Studies focussing on SCD in patients with HCM without ICD were excluded. Literature SearchThe online MEDLINE database was searched for literature in Background-Previous observational studies demonstrated that patients with hypertrophic cardiomyopathy at risk for sudden cardiac death (SCD) may benefit from implantable cardioverter defibrillator (ICD) therapy. A complete overview of outcome and complications after ICD therapy is currently not available. This study pools data from published studies on outcome and complications after ICD therapy in patients with hypertrophic cardiomyopathy. Methods and Results-A PubMed database search returned 27 studies on 16 cohorts reporting outcome and complications after ICD therapy in patients with hypertrophic cardiomyopathy. In case of >1 publications on a particular cohort, the publication with the largest number of patients was included in the meta-analysis. ICD interventions, complications, and mortality rates were extracted, pooled, and analyzed. There were 2190 patients (mean age, 42 years; 38% women), most of whom (83%) received an ICD for primary prevention of SCD. Risk factors for SCD were left ventricular wall thickness ≥30 mm (20%), family history of SCD (43%), nonsustained ventricular tachycardia (46%), syncope (41%), and abnormal blood pressure response (25%). During the 3.7-year follow-up, the annualized cardiac mortality rate was 0.6%, the noncardiac mortality rate was 0.4%, and the appropriate ICD intervention rate was 3...

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“…The central role of ventricular arrhythmias in the pathogenesis of SCD in HCM is supported by the observation that HCM patients treated with ICD receive appropriate therapies. [10][11][12][13][14][15][16][17][18] Systematic analysis of stored electrograms shows that the majority of ventricular arrhythmias occur while in normal sinus rhythm and are precipitated by premature ventricular complexes. 19 In addition, data from chance electrocardiographic recordings have shown that ventricular fibrillation can be precipitated by runs of ventricular tachycardia, rapid atrial fibrillation (AF), or accelerated atrioventricular conduction.…”

Section: Sudden Cardiac Death and Underlying Mechanismsmentioning

confidence: 99%

“…Data published to date show that SCD is rare in ICD recipients, and they receive appropriate device therapies that terminate potentially life-threatening ventricular arrhythmias. [10][11][12][13][14][15][16][17][18] However, ICD implantation in HCM is associated with considerable morbidity, secondary to inappropriate shocks and implant-related complications (Figure). 18 Moreover, a substantial number of ICD recipients have a poor quality of life and psychological status, with significant occupational and lifestyle restrictions.…”

Section: Prevention Of Scd: Antiarrhythmic Treatment and Icdmentioning

confidence: 99%

Sudden Cardiac Death in Hypertrophic Cardiomyopathy

O’Mahony

Elliott

McKenna

2013

Circ: Arrhythmia and Electrophysiology

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SCD in HCM has been linked with physical exertion. 33 A vicious cycle of increasing myocardial ischemia, caused by diastolic dysfunction, LVOTO, systemic hypotension, and decreased stroke volume, has been suggested, but SCD can occur at rest or sleep, 33 when metabolic demands are low. The exact triggers of ventricular arrhythmias remain unclear. Risk Factors of SCD in HCMVarious phenotypic characteristics have been linked with SCD and are currently used to identify patients at risk. 34,35 These risk factors were first noted in small, comparative observational studies, and then re-examined in larger studies with multivariable survival analysis using the Cox proportional

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Implantable Cardioverter Defibrillator and Hypertrophic Cardiomyopathy. Experience at Three Centers

Cited by 13 publications

References 37 publications

Risk Stratification and Role of Implantable Defibrillators for Prevention of Sudden Death in Patients With Hypertrophic Cardiomyopathy

Risk Stratification and Role of Implantable Defibrillators for Prevention of Sudden Death in Patients With Hypertrophic Cardiomyopathy

Outcome and Complications After Implantable Cardioverter Defibrillator Therapy in Hypertrophic Cardiomyopathy

Sudden Cardiac Death in Hypertrophic Cardiomyopathy

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