Perspectives on Sudden Death Prevention in Hypertrophic Cardiomyopathy

Sudden death (SD) is the most dramatic event in hypertrophic cardiomyopathy (HCM), often representing the first clinical manifestation of the disease, and the first concern of the clinicians who take care of such patients. HCM is now recognized as the primary cause of SD in young persons (<35 years of age), including trained athletes. Current data in unselected HCM patient populations report an approximate 0.7% per year incidence of SD, with the total cardiovascular mortality being around 1.4% annually. This review, incorporating contemporary research findings, addresses the major aspects of SD and its prevention in HCM. The traditional risk factors and other controversial risk factors for SD or the arbitrators for that event are thoroughly analyzed and the need for the development of a unique and accurate factor for SD risk stratification is discussed. Rather than enumerating clinical studies and guidelines, challenging problems concerning all aspects of SD in HCM, are critically appraised, highlighting current speculations and recommending future directions.