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Sustained arrhythmias in hypertrophic obstructive cardiomyopathy
The New England Journal of Medicine
|June 14, 1984
Summary
Arrhythmias cause syncope and sudden death in hypertrophic obstructive cardiomyopathy. Electrophysiologic studies identify these arrhythmias, guiding effective antiarrhythmic drug therapy and preventing symptom recurrence.
Area of Science:
- Cardiology
- Electrophysiology
- Internal Medicine
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) patients experience syncope and sudden death.
- Ventricular ectopy and tachycardia in HOCM indicate a high risk of sudden cardiac death.
Purpose of the Study:
- To investigate if induced sustained arrhythmias explain cerebral dysfunction in HOCM.
- To assess the utility of electrophysiologic studies in guiding therapy for HOCM patients.
Main Methods:
- Prospective evaluation of seven symptomatic HOCM patients.
- Atrial and ventricular stimulation to induce arrhythmias.
- Selection of antiarrhythmic drugs based on electrophysiologic testing results.
Main Results:
- Electrophysiologic abnormalities were identified in all seven patients.
- Diagnoses included supraventricular tachycardia, sustained ventricular tachycardia, ventricular fibrillation, and prolonged QT interval with dispersion of ventricular refractoriness.
- No symptom recurrence observed during 120 patient-months of follow-up.
Conclusions:
- Arrhythmias are a primary cause of syncope and sudden death in obstructive cardiomyopathy.
- Electrophysiologic study is valuable for selecting prophylactic antiarrhythmic therapy in HOCM.