June 1, 2007
View Full PaperSustained Ventricular Tachycardia in Apical Hypertrophic Cardiomyopathy, Midcavitary Obstruction, and Apical Aneurysm
Key Result
Apical hypertrophic cardiomyopathy with apical aneurysms may carry a higher lifetime risk of cardiovascular death than the 2% risk in general HCM, with ICD implantation serving as definitive therapy.
Structured PICO
Does automatic implantable cardioverter defibrillator (AICD) implantation prevent cardiovascular death in patients with apical hypertrophic cardiomyopathy, midcavitary obstruction, and apical aneurysm compared to medical therapy?
P
Population
Patients with apical hypertrophic cardiomyopathy, midcavitary obstruction, and apical aneurysm
I
Intervention
Automatic implantable cardioverter defibrillator (AICD) implantation
C
Comparator
Medical therapy
O
Outcome
Cardiovascular deathhard clinical
In patients with apical hypertrophic cardiomyopathy complicated by midcavitary obstruction and apical aneurysm, AICD implantation is considered definitive therapy due to the variable success of medical management.
Abstract
The prevalence of hypertrophic cardiomyopathy is estimated at 1:500 in the general population. Of these patients, approximately 1% develops midcavitary obstruction and subsequent apical aneurysm. We present a brief review of the literature on apical hypertrophic cardiomyopathy (HCM) using a rare case-based example. The etiology for apical aneurysm development is unclear but is thought to extend from apical fibrosis and necrosis secondary to subendocardial ischemia. The lifetime risk of cardiovascular death in patients with HCM is 2%. However, the risk may be higher in patients with apical aneurysms. Definitive therapy involves implantation of an automatic implantable cardioverter defibrillator, since medical therapy has variable success.