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Sudden Cardiac Death Risk over Time in HCM Patients with Implantable Cardioverter-Defibrillator

Mariusz Klopotowski1, Krzysztof Kukula1, Jacek Jamiolkowski2

  • 1Department of Interventional Cardiology and Angiology, Cardinal Wyszynski National Institute of Cardiology, 04-628 Warsaw, Poland.

Journal of Clinical Medicine
|March 25, 2022
PubMed

Insights

Sudden cardiac death (SCD) risk in hypertrophic cardiomyopathy (HCM) patients with an implantable cardioverter-defibrillator (ICD) is generally stable or decreases over time. Re-evaluating risk is crucial when considering ICD re-implantation.

Area of Science:

  • Cardiology
  • Genetics
  • Internal Medicine

Background:

  • Hypertrophic cardiomyopathy (HCM) patients at high risk of sudden cardiac death (SCD) warrant implantable cardioverter-defibrillator (ICD) consideration.
  • Current European Society of Cardiology (ESC) guidelines suggest SCD risk in HCM is not static.
  • The study addresses the dynamic nature of SCD risk in HCM patients over time.

Purpose of the Study:

  • To evaluate changes in calculated 5-year SCD risk in HCM patients previously implanted with an ICD.
  • To compare SCD risk between HCM patients undergoing first-time ICD implantation versus ICD re-implantation.

Main Methods:

  • Analysis of 64 HCM patients with prior ICDs (re-implantation group) and 32 HCM patients receiving a first-time ICD.
  • Assessment of 5-year SCD risk using the ESC risk calculator for eligible patients.
  • Comparison of risk profiles between the two patient groups.

Main Results:

  • The first-time ICD implantation group exhibited a higher 5-year SCD risk (7.50 IQR 5.98–10.46) compared to the re-implantation group (4.88 IQR 3.42–7.25).
  • Among patients initially below 4% risk, 22% saw an increase, while 78% remained stable.
  • Of those initially at or above 6% risk, 31% experienced a decrease to below 6%, with 14% dropping below 4%.

Conclusions:

  • SCD risk in HCM patients typically remains stable or decreases.
  • Periodic risk re-evaluation is essential, particularly when considering ICD re-implantation in HCM patients.
  • These findings underscore the need for dynamic risk assessment in managing HCM patients with ICDs.

Keywords:
hypertrophic cardiomyopathyimplantable cardioverter-defibrillatorrisksudden cardiac death

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