Clinical data lacks confirmatory evidence that hypertensive left ventricular hypertrophy independently causes sustained ventricular arrhythmias and sudden cardiac death, often due to confounding by coronary artery disease.
Does hypertensive left ventricular hypertrophy cause sustained ventricular arrhythmias in humans?
Hypertensive left ventricular hypertrophy alone does not appear to be an isolated risk factor for sustained ventricular arrhythmias and sudden cardiac death, which are more likely driven by co-existent coronary artery disease.
Sudden cardiac death (SCD) is most commonly secondary to sustained ventricular arrhythmias (VAs). This review aimed to evaluate if left ventricular hypertrophy (LVH) secondary to systemic hypertension in humans is an isolated risk factor for ventricular arrhythmogenesis. Animal models of hypertensive LVH have shown changes in ion channel function and distribution, gap junction re-distribution and fibrotic deposition. Clinical data has consistently exhibited an increase in prevalence and complexity of non-sustained VAs on electrocardiographic monitoring. However, there is a dearth of trials suggesting progression to sustained VAs and SCD, with extrapolations being confounded by presence of co-existent asymptomatic coronary artery disease (CAD). Putatively, this lack of data may be due to the presence of more homogenous distribution of pathophysiological changes seen in those with hypertensive LVH versus known pro-arrhythmic conditions such as HCM and myocardial infarction. The overall impression is that sustained VAs in the context of hypertensive LVH are most likely to be precipitated by other causes such as CAD or electrolyte disturbance.
Nadarajah et al. (2021) conducted a review in Hypertensive left ventricular hypertrophy. Hypertensive left ventricular hypertrophy was evaluated on Sustained ventricular arrhythmias and sudden cardiac death. Clinical data lacks confirmatory evidence that hypertensive left ventricular hypertrophy independently causes sustained ventricular arrhythmias and sudden cardiac death, often due to confounding by coronary artery disease.