Arrhythmic Disease Progression in Hypertrophic Cardiomyopathy During 4 Years of Follow-Up Evaluation
Louise Bjerregaard1,2, Christoffer Harboe Nielsen1,2, Steen Hvitfeldt Poulsen1,2
1Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Insights
Hypertrophic cardiomyopathy (HCM) patients show modest progression of arrhythmias over 4 years. While nonsustained ventricular tachycardia (NSVT) risk remained stable, premature ventricular contractions and atrial fibrillation increased significantly.
Area of Science:
- Cardiology
- Electrophysiology
- Genetic Heart Diseases
Background:
- Forty-eight-hour Holter-monitoring (HM) is crucial for detecting nonsustained ventricular tachycardia (NSVT) in hypertrophic cardiomyopathy (HCM) patients.
- Understanding the long-term risk of NSVT and arrhythmic progression is essential for managing HCM.
Purpose of the Study:
- To estimate the cumulative 48-hour risk of NSVT in HCM patients.
- To assess the progression of arrhythmic disease during follow-up evaluations.
Main Methods:
- Retrospective analysis of 97 HCM patients from 2017-2020 with at least two HM periods.
- Follow-up duration averaged 4.3 years, with Cox regression analysis for event rates.
Main Results:
- The cumulative 48-hour NSVT risk was 31% initially and 37% at latest follow-up, with no significant difference in event rates (HR 1.27, P=0.33).
- Age did not significantly affect NSVT risk (HR 1.01, P=0.15).
- Atrial fibrillation increased significantly (0% to 6%, P=0.01), and premature ventricular contractions occurred more frequently at latest follow-up (P=0.01).
Conclusions:
- HCM patients exhibit modest arrhythmic progression over a 4-year period.
- Significant increases in premature ventricular contractions and atrial fibrillation were observed.
- A trend towards increased NSVT suggests the need for continued monitoring.
Background:
Forty-eight-hour Holter-monitoring (HM) is recommended to identify nonsustained ventricular tachycardia (NSVT) in patients with hypertrophic cardiomyopathy (HCM). This study aims to estimate the cumulative 48-hour risk of NSVT in HCM and assess arrhythmic disease progression during follow-up evaluation.
Methods:
HCM patients were retrospectively identified from 2017 to 2020 and were evaluated from patient records. Patients with a minimum of 2 available HM periods were included.
Results:
We identified 97 HCM patients, with a mean age of 47 ± 16 years, and 68% of whom were male. From the first to the latest HM period, the mean follow-up duration was 4.3 ± 2.5 years. The cumulative 48-hour risk of NSVT was 31% in the first HM period, compared to 37% in the latest period. No difference occurred in number of ventricular cycles or frequency of NSVT. Cox regressions analysis showed that no significant difference occurred in event rates of NSVT between the first and the latest HM periods (hazard ratio 1.27; 95% confidence interval [CI] 0.78-2.06; P = 0.33) and that age had no effect on the risk of NSVT (hazard ratio 1.01; 95% confidence interval 0.99-1.03; P = 0.15). In the latest HM period, atrial fibrillation was identified in 6% of patients, compared to none in the first HM period (P = 0.01). Premature ventricular contractions occurred more often in the first HM period (25, interquartile range 5, 170) compared to the latest HM period (50, interquartile range 14, 360, P = 0.01).
Conclusions:
This study demonstrated a modest arrhythmic disease progression in HCM patients during a 4-year follow-up period, with a significant increase in premature ventricular contractions and atrial fibrillation, and a trend toward an increase in NSVT.
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