Key result
The implantable cardioverter-defibrillator effectively prevents sudden cardiac death in hypertrophic cardiomyopathy, with appropriate intervention rates of 11% per year for secondary prevention and 5% per year for primary prevention.
Why the study?
Does implantable cardioverter-defibrillator prevent sudden cardiac death in patients with hypertrophic cardiomyopathy?
Does implantable cardioverter-defibrillator prevent sudden cardiac death in patients with hypertrophic cardiomyopathy?
This review highlights the efficacy of ICDs for sudden cardiac death prevention in HCM while emphasizing the need for improved risk stratification and awareness of long-term complications.
Supports ICD use for SCD prevention in HCM; leaves open refined risk stratification and long-term complication awareness.
Sudden cardiac death (SCD) is the most devastating complication in hypertrophic cardiomyopathy (HCM). The implantable cardioverter-defibrillator (ICD) has proven to be effective in SCD prevention in several clinical scenarios. In HCM population, it has demonstrated to successfully abort life-threatening ventricular arrhythmias despite the extreme morphology characteristic of HCM, often with massive degrees of left ventricular hypertrophy and/or LV outflow tract obstruction. Studies showed a high rate of appropriate intervention in secondary prevention and in primary prevention of patients considered at high risk. This appropriate intervention rate is even more significant considering the young and otherwise healthy patients that compose HCM population. Since SCD incidence in HCM is relatively low, optimal identification of patients at high risk is crucial. Classical strategy of risk stratification based on clinical risk factors has several limitations and has proven to overestimate risk. A new risk prediction model that provides individual 5-year estimated risk appears to be superior to traditional models based on bivariate risk factors. Perioperative complications seem to be similar to those related to the implant of other cardiac devices, while long-term complications have been traditionally in the spotlight. HCM patients are considered more vulnerable to ICD-related complications and inappropriate ICD therapy because of their young age at implant and increased prevalence of atrial fibrillation, but long-term follow-up data on ICD-related complications in general practice is limited. The subcutaneous implantable cardioverter defibrillator seems to be a safe and effective alternative in HCM, although long-term data are scarce.
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Sánchez et al. (2018) conducted a review in Hypertrophic cardiomyopathy. Implantable cardioverter-defibrillator (ICD) was evaluated. The implantable cardioverter-defibrillator effectively prevents sudden cardiac death in hypertrophic cardiomyopathy, with appropriate intervention rates of 11% per year for secondary prevention and 5% per year for primary prevention.
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