Long-Term Outcome in High-Risk Patients With Hypertrophic Cardiomyopathy After Primary Prevention Defibrillator Implants
Key result
Primary prevention ICDs in HCM deliver appropriate therapy to ~21% of patients over a decade.
- n=217
Why the study?
Data on the performance and complications of primary prevention ICDs in hypertrophic cardiomyopathy over particularly long time periods are incomplete.
What is the long-term performance and complication rate of primary prevention ICDs in patients with hypertrophic cardiomyopathy?
Population
217 consecutive hypertrophic cardiomyopathy patients with primary prevention ICDs implanted before 2008
Design
Cohort study
Follow-up
Mean 12±4 years (range to 31)
Authors
Discussion
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Member takes
Implication
Supports long-term ICD follow-up in HCM; leaves open optimal selection criteria for prospective trials.
Key Points
- To evaluate the very long-term performance, therapy patterns, and complication rates of primary prevention implantable cardioverter-defibrillators (ICDs) in patients with hypertrophic cardiomyopathy followed for at least a decade.
- Retrospective cohort analysis of N=217 consecutive patients with hypertrophic cardiomyopathy who received primary prevention ICDs before 2008.
- Patients had a mean age of 38±17 years at implantation and were followed for ≥10 years (mean 12±4 years; range up to 31 years).
- Appropriate ICD therapy for ventricular tachycardia/fibrillation occurred in 45 patients (21%), with initial therapy rates rising from 2.3% at <1 year to 8.5% at ≥10 years (P=0.005), and 64% of first shocks occurring ≥5 years post-implant.
- Inappropriate shocks occurred in 39 patients (18%), decreasing significantly from 9.7% of patients at <5 years to 3.8% at ≥10 years (P=0.02).
- Major device complications occurred in 27 patients (12%) without increasing frequency over extended follow-up (P=0.47), and zero arrhythmic sudden deaths occurred in the cohort.
Study Design
Type
Cohort (n=217)
Structured PICO
What is the long-term performance and complication rate of primary prevention ICDs in patients with hypertrophic cardiomyopathy?
P
Population
217 consecutive hypertrophic cardiomyopathy patients with primary prevention ICDs implanted before 2008 and followed for ≥10 years, mean age 38±17 years at implant.
I
Intervention
Implantable cardioverter-defibrillator (ICD) for primary prevention
O
Outcome
Appropriate interventions terminating ventricular tachycardia/ventricular fibrillation, inappropriate ICD shocks, and major device complications over long-term follow-uphard clinical
In HCM patients with primary prevention ICDs, appropriate therapies often occur after prolonged periods (>5-10 years) of dormancy, highlighting the need for long-term device maintenance.
Cite This Study
Rowin et al. (2020) conducted a cohort in Hypertrophic cardiomyopathy (n=217). Implantable cardioverter-defibrillator (ICD) was evaluated on Appropriate interventions terminating ventricular tachycardia/ventricular fibrillation. Primary prevention ICD therapy in hypertrophic cardiomyopathy resulted in appropriate interventions in 21% of patients over ≥10 years, with 64% of discharges occurring ≥5 years after implant.