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Ventricular arrhythmias in patients with hypertrophic cardiomyopathy: Prevalence, distribution, predictors, and

Amitai Segev1, Yishay Wasserstrum1, Michael Arad1

  • 1Leviev Heart Center, Sheba Medical Center, Affiliated With Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

Heart Rhythm
|June 29, 2023
PubMed

Insights

In hypertrophic cardiomyopathy (HCM), ventricular tachycardia (VT) is more common than ventricular fibrillation (VF). Antitachycardia pacing (ATP) is effective for VT in HCM patients with specific left ventricular (LV) characteristics.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Genetics

Background:

  • Hypertrophic cardiomyopathy (HCM) is associated with an elevated risk of sudden cardiac death, often attributed to ventricular fibrillation (VF).
  • Understanding the specific arrhythmias in HCM is crucial for risk stratification and management.

Purpose of the Study:

  • To determine the incidence and predictors of sustained ventricular arrhythmias (VTAs) in patients with HCM.
  • To compare the characteristics of VF versus ventricular tachycardia (VT) in this population.

Main Methods:

  • Retrospective analysis of HCM patients with implantable cardioverter-defibrillators (ICDs) from a prospectively collected registry.
  • Collection and comparison of clinical, electrocardiographic, echocardiographic, ICD interrogation, and genetic data.

Main Results:

  • Sustained VTAs occurred in 18% of HCM patients with ICDs over a mean follow-up of 10 years.
  • Ventricular tachycardia (VT), particularly monomorphic VT, was the most common arrhythmia (70%), associated with decreased left ventricular ejection fraction and increased LV dimensions.
  • Antitachycardia pacing (ATP) successfully terminated 79% of VT events; mortality rates were similar between patients with and without VTAs.

Conclusions:

  • Ventricular tachycardia (VT), not VF, is the predominant arrhythmia in HCM patients requiring ICDs.
  • VT in HCM is often responsive to ATP and linked to specific left ventricular (LV) structural abnormalities.
  • ATP-capable ICDs may be beneficial for HCM patients exhibiting these LV features.
Abstract

Keywords:
ATPHCMICDS-ICDVentricular arrhythmia

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