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Implantable Cardioverter-Defibrillator Therapy in Apical Hypertrophic Cardiomyopathy: Insights From a Multicenter

Yae Min Park1, Jaemin Shim2, Mi Suk Cha1

  • 1Division of Cardiology, Gachon University Gil Medical Center, Incheon, Korea.

Korean Circulation Journal
|May 28, 2026
PubMed

Insights

Sudden cardiac death (SCD) risk markers are present in apical hypertrophic cardiomyopathy (HCM) patients receiving implantable cardioverter-defibrillators (ICDs). Apical HCM patients with ICDs showed similar long-term outcomes to non-apical HCM patients.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Genetics

Background:

  • Sudden cardiac death (SCD) risk stratification in apical hypertrophic cardiomyopathy (HCM) requires further definition.
  • Established SCD risk markers and implantable cardioverter-defibrillator (ICD) outcomes are not well-characterized in apical HCM.

Purpose of the Study:

  • To evaluate SCD risk markers in apical HCM patients with aborted cardiac arrest (ACA) or ventricular fibrillation (VF).
  • To compare long-term ICD therapy outcomes between apical and non-apical HCM patients.

Main Methods:

  • Analysis of 96 HCM patients who underwent ICD implantation.
  • Assessment of 2024 AHA/ACC and 2023 ESC guideline-recommended SCD risk markers in apical HCM patients with ACA/VF.
  • Comparison of long-term ICD therapy outcomes between apical and non-apical HCM cohorts.

Main Results:

  • Apical HCM patients (15.6%) with ACA/VF (46.7%) presented with at least one SCD risk marker.
  • Common risk markers included late gadolinium enhancement, syncope, non-sustained ventricular tachycardia, and left atrial enlargement.
  • No significant differences in total or appropriate ICD therapy events were found between apical and non-apical HCM groups over ~6 years.

Conclusions:

  • Apical HCM patients receiving ICDs for secondary prevention exhibit significant risk markers and remain at risk for ventricular arrhythmias.
  • Risk-guided ICD implantation and diligent long-term follow-up are recommended for high-risk apical HCM patients.
Abstract

Keywords:
Aborted cardiac arrestApical hypertrophic cardiomyopathyImplantable cardioverter-defibrillatorOutcomesSudden cardiac death

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