Name:
Hypertrophic Cardiomyopathy and Sudden Cardiac Death
Description:
Hypertrophic Cardiomyopathy and Sudden Cardiac Death
Thumbnail URL:
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Duration:
T00H05M13S
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Upload Date:
2022-02-28T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
>> Practice Impact Extra podcasts are derived from Hurst's The Heart Board Review and other online resources available only through accesscardiology.com. >> Hypertrophic cardiomyopathy is a complex type of heart disease caused by thickening of the heart muscle. Its symptoms can include shortness of breath, chest pain, and arrhythmia that can lead to sudden cardiac death. Here's a question. Is it possible to identify most patients with hypertrophic cardiomyopathy at risk of sudden cardiac death and to prevent such events with the implantation of an ICD?
Hi, Dr. Bernie here, and welcome to Practice Impact Extra. [inaudible] years of hypertrophic cardiomyopathy, sudden cardiac death has been the most visible and devastating disease complication, leading to the recognition of this disease as a common cause of sudden cardiac death in the young. With the introduction of the ICD [inaudible] hypertrophic cardiomyopathy almost 20 years ago, this had the capability to terminate potentially lethal ventricular tachyarrhythmia, and the prevention of sudden cardiac death has become a reality for many patients.
Strategies for reliable selection of high-risk patients with hypertrophic cardiomyopathy for the prevention of sudden cardiac death with ICD were incompletely resolved. Researchers set out with an objective to assess the reliability of sudden cardiac death predicting models that would lead to the prophylactic implantation of an ICD to reduce the number of sudden cardiac death in the patients with hypertrophic cardiomyopathy.
An observational longitudinal study of 2094 predominantly adults with hypertrophic cardiomyopathy were followed over 17 years in a large center particularly directed at hypertrophic cardiomyopathy. Risk stratification protocol presented represents now the enhanced American College of Cardiology and American Heart Association strategy for prevention of sudden cardiac death in high-risk patients with hypertrophic cardiomyopathy.
Based on these enhanced guidelines, a primary prevention ICD was recommended based on the presence of more than one of these following risk markers, a family history of sudden cardiac death due to hypertrophic cardiomyopathy, left ventricular wall thickness of 30 millimeters or greater, unexplained syncope, non-sustained ventricular tachycardia, late gadolinium enhancement identifying fibrosis on contrast cardiac imaging on MRI, ejection fraction of less than 50%, and left ventricular apical aneurysm.
What were the main outcomes and results? An ICD was implanted based on prospective risk factor analysis of 527 patients based on one or more major risk markets. And 16%, 82 of 527 patients, with a prophylactic ICD experienced a device firing to terminate ventricular tachycardia or ventricular fibrillation. That's compared to only 5 patients with hypertrophic-cardiomyopathy-related sudden cardiac death in the remaining 1567 patients who did not get an ICD, and this actually included two individuals who declined device therapy, even though they did have some guideline thoughts and recommendations to have an ICD.
The risk factors used in this study predicted sudden cardiac death event with a sensitivity of 95%. The sensitivity of identification of those at risk was 95%. So, what is the prospective and the relevant? The systematic enhanced ACC and American Heart Association guidelines identified almost all hypertrophic cardiomyopathy patients who were at risk of sudden cardiac death and who appropriate -- and who are the appropriate candidates for ICD implantation, preventing many catastrophic arrhythmic events in this at-risk population.
Thank you for joining me. See you next time on Practice Impact Extra. >> We hope you enjoyed this podcast from McGraw-Hill. Subscribers to AccessCardiology have instant access to over 25,000 pages of rich medical content, receive medical updates from trusted experts, and have access to other special features. To subscribe or learn more, please visit accesscardiology.com.
