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Programmed electrical stimulation in patients with hypertrophic cardiomyopathy
K H Kuck1, K P Kunze, M Geiger
1Department of Cardiology, University Hospital Eppendorf, Hamburg, F.R.G.
Insights
Programmed electrical stimulation cannot reliably predict adverse events in hypertrophic cardiomyopathy patients. This diagnostic tool failed to differentiate between patients with a history of cardiac arrest, syncope, or those who were asymptomatic.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Hypertrophic cardiomyopathy (HCM) is a complex cardiac condition.
- Identifying patients at risk for life-threatening ventricular arrhythmias is crucial.
Purpose of the Study:
- To evaluate the efficacy of programmed electrical stimulation (PES) in stratifying risk in HCM patients.
- To determine if PES can distinguish between HCM patients with different clinical presentations.
Main Methods:
- Fifty-four HCM patients underwent programmed electrical stimulation.
- Patients were categorized into three groups: prior cardiac arrest, syncope, or asymptomatic.
- Atrial and ventricular stimulation protocols were used to induce arrhythmias.
Main Results:
- Ventricular arrhythmias were induced in 18 patients (33%).
- The type and incidence of induced arrhythmias did not differ significantly across the three patient groups.
- No significant differences were observed in electrocardiographic, echocardiographic, or hemodynamic data between groups.
Conclusions:
- Programmed electrical stimulation with up to two extrastimuli is not effective in differentiating HCM patients at risk for adverse events.
- Current PES protocols lack the sensitivity to stratify risk in HCM based on clinical history.
Abstract:
Programmed electrical stimulation was performed in 54 consecutive patients with hypertrophic cardiomyopathy. Three patients had a history of cardiac arrest due to ventricular tachyarrhythmias (group A), eight patients had a history of syncope of unknown origin (group B), and 43 patients were "asymptomatic", i.e. they had no documented or suspected symptomatic ventricular arrhythmias (group C). There were no differences among the groups with respect to electrocardiographic, echocardiographic or hemodynamic data. Ventricular arrhythmias were induced by atrial and right and left ventricular stimulation with a maximum of two extrastimuli in 18 patients. Induced arrhythmias were repetitive ventricular response in six patients, nonsustained ventricular tachycardia in four, sustained ventricular tachycardia in five, and ventricular fibrillation in three patients. Ventricular tachycardia was always rapid with a mean cycle length of 194 +/- 20 ms. In one group A patient, rapid ventricular tachycardia was induced during atrial stimulation. The type and incidence of induced ventricular arrhythmias did not differ among the three groups. It is concluded that programmed stimulation with a maximum of two ventricular extrastimuli cannot distinguish between patients with hypertrophic cardiomyopathy who had either cardiac arrest or syncope or were "asymptomatic".