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Implantable cardioverter-defibrillator therapy in hypertrophic cardiomyopathy: A SIMPLE substudy

Mate Vamos1, Jeff S Healey2, Jia Wang3

  • 1University Hospital Frankfurt, Goethe University, Frankfurt, Germany.

Heart Rhythm
|November 22, 2017
PubMed

Insights

Defibrillation testing (DT) in hypertrophic cardiomyopathy (HCM) patients undergoing implantable cardioverter-defibrillator (ICD) insertion showed no significant difference in outcomes compared to other cardiomyopathies. DT did not improve shock efficacy in HCM patients.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Hypertrophic cardiomyopathy (HCM) patients face higher risks for defibrillation issues and complications with implantable cardioverter-defibrillators (ICDs).
  • Assessing the necessity and impact of defibrillation testing (DT) in these high-risk patients is crucial for optimizing ICD therapy.

Purpose of the Study:

  • To evaluate the value of defibrillation testing (DT) in patients with hypertrophic cardiomyopathy (HCM) undergoing implantable cardioverter-defibrillator (ICD) implantation.
  • To compare DT efficacy, perioperative complications, and long-term outcomes in HCM patients versus those with ischemic cardiomyopathy (ICM) or dilated cardiomyopathy (DCM).

Main Methods:

  • The study analyzed data from the SIMPLE trial, comparing HCM patients with ICM/DCM patients who underwent ICD insertion.
  • Outcomes including defibrillation thresholds, perioperative complications, and long-term mortality were assessed.
  • HCM patients were further analyzed based on randomization to DT or no DT groups.

Main Results:

  • Defibrillation safety margins were similar between HCM (88.5%) and ICM/DCM (90.5%) patients.
  • Perioperative complications were comparable across HCM with DT (1.9%), ICM/DCM with DT (6.4%), and HCM without DT (7.1%).
  • Long-term outcomes such as all-cause mortality, arrhythmic events, and shock complications did not significantly differ between HCM and ICM/DCM groups, nor between HCM patients with or without DT.

Conclusions:

  • Defibrillation testing (DT) did not demonstrate a significant benefit in improving intraoperative or clinical shock efficacy in hypertrophic cardiomyopathy (HCM) patients.
  • No significant differences were observed in intraoperative defibrillation efficacy, perioperative complications, or long-term outcomes between HCM and other cardiomyopathy groups (ICM/DCM).
Abstract

Keywords:
Defibrillation testingHypertrophic cardiomyopathyImplantable cardioverter–defibrillator

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