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Primary prevention implantable cardioverter-defibrillators in hypertrophic cardiomyopathy-Are there predictors of appropriate therapy?
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- Additional Information
- Source:
Publisher: Elsevier Country of Publication: United States NLM ID: 101200317 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1556-3871 (Electronic) Linking ISSN: 15475271 NLM ISO Abbreviation: Heart Rhythm Subsets: MEDLINE
- Publication Information:
Original Publication: New York, NY : Elsevier, c2004-
- Subject Terms:
Cardiomyopathy, Hypertrophic/
*therapy ;
Death, Sudden, Cardiac/
*prevention & control ;
Defibrillators, Implantable/
*adverse effects ;
Heart Rate/
*physiology ;
Primary Prevention/
*methods ;
Risk Assessment/
*methods ;
Tachycardia, Ventricular/
*therapy;
Adult ;
Cardiomyopathy, Hypertrophic/
physiopathology ;
Death, Sudden, Cardiac/
epidemiology ;
Death, Sudden, Cardiac/
etiology ;
Equipment Failure ;
Female ;
Follow-Up Studies ;
Humans ;
Male ;
Middle Aged ;
Ontario/
epidemiology ;
Prognosis ;
Retrospective Studies ;
Risk Factors ;
Survival Rate/
trends ;
Tachycardia, Ventricular/
epidemiology ;
Tachycardia, Ventricular/
physiopathology ;
Time Factors - Abstract:
Background: Identifying patients with hypertrophic cardiomyopathy (HCM) who warrant a primary prevention implantable cardioverter-defibrillator (ICD) is crucial. ICDs are effective in terminating life-threatening arrhythmias; however, ICDs carry risks of complications.
Objective: The purpose of this study was to assess the incidence and predictors of appropriate ICD therapies, inappropriate shocks, and device-related complications in patients with HCM and primary prevention ICDs.
Methods: All patients with HCM who underwent primary prevention ICD implantation at Toronto General Hospital between September 2000 and December 2017 were identified. Therapies (shocks or antitachycardia pacing) for ventricular tachycardia >180 beats/min or ventricular fibrillation were considered appropriate.
Results: Three hundred two patients were followed for a mean 6.1 ± 4.3 years (1801 patient-years of follow-up). Thirty-eight patients (12.6%) received at least 1 appropriate ICD therapy (2.3%/y); the 5-year cumulative probability of receiving appropriate ICD therapy was 9.6%. None of the conventional risk factors nor the European Society of Cardiology risk score was associated with appropriate ICD therapy. In multivariable analysis, age < 40 years at implantation and atrial fibrillation were independent predictors of appropriate ICD therapy. In a subgroup of patients who had undergone cardiac magnetic resonance imaging before ICD implantation, severe late gadolinium enhancement was the strongest predictor of appropriate ICD therapies. ICD-related complications or inappropriate shocks occurred in 87 patients (28.8%), with an inappropriate shock rate of 2.1%/y; the 5-year cumulative probability was 10.7%.
Conclusion: The incidence of appropriate ICD therapies in patients with HCM and primary prevention ICDs is lower than previously reported; a high proportion of patients suffer from an ICD-related complication. Traditional risk factors have low predictive utility. Severe late gadolinium enhancement, atrial fibrillation, and young age are important predictors of ventricular tachyarrhythmias in HCM.
(Copyright © 2020 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
- Contributed Indexing:
Keywords: Appropriate implantable cardioverter-defibrillator therapy; Hypertrophic cardiomyopathy; Primary prevention implantable cardioverter-defibrillator; Sudden cardiac death; Ventricular arrhythmia
- Publication Date:
Date Created: 20200818 Date Completed: 20211117 Latest Revision: 20211117
- Publication Date:
20240829
- Accession Number:
10.1016/j.hrthm.2020.08.009
- Accession Number:
32800967
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