Electrophysiologic manifestations of ventricular tachyarrhythmias provoking appropriate defibrillator interventions in high-risk patients with hypertrophic cardiomyopathy

Yong-Mei Cha, Bernard J. Gersh, Barry J. Maron, Giuseppe Boriani, Paolo Spirito, David O. Hodge, Peggy L. Weivoda, Jane M. Trusty, Paul Andrew Friedman, Stephen C. Hammill, Robert F. Rea, Win Kuang Shen

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Introduction: Our objective was to determine features of ventricular tachyarrhythmias triggering appropriate implantable cardioverter-defibrillator (ICD) interventions in hypertrophic cardiomyopathy (HCM). Methods and Results: The study cohort was 68 high-risk HCM patients who received ICDs for primary sudden cardiac death prevention from 1995 to 2003. All episodes of sustained ventricular tachyarrhythmias identified by stored intracardiac electrograms were analyzed. Nine patients had 51 episodes of sustained ventricular tachyarrhythmic events that required device therapy (mean follow-up, 3.4 ± 2.2 years; cumulative event rate, 3.2% per year): five had 47 episodes of monomorphic ventricular tachycardia (VT); four each had one episode of ventricular fibrillation (VF). Sinus tachycardia or atrial fibrillation was the initiating rhythm in five of nine patients and in 43 of 51 episodes of events. Of the 17 episodes of monomorphic VT detected in the VT zone, 16 (94%) were terminated by antitachycardia pacing. Thirty episodes of monomorphic VT were detected in the VF zone and were terminated by defibrillation. Conclusion: Sustained monomorphic VT is common in a high-risk cohort with HCM. Sinus tachycardia is often the initiating rhythm, suggesting that high sympathetic drive may be proarrhythmic when a susceptible substrate is present. Antitachycardia pacing is highly effective in terminating VT in this patient population.

Original languageEnglish (US)
Pages (from-to)483-487
Number of pages5
JournalJournal of Cardiovascular Electrophysiology
Volume18
Issue number5
DOIs
StatePublished - May 2007

Fingerprint

Defibrillators
Hypertrophic Cardiomyopathy
Ventricular Tachycardia
Tachycardia
Sinus Tachycardia
Ventricular Fibrillation
Cardiac Electrophysiologic Techniques
Implantable Defibrillators
Sudden Cardiac Death
Atrial Fibrillation
Cohort Studies
Equipment and Supplies
Population

Keywords

  • Antitachycardia therapy
  • Hypertrophic cardiomyopathy
  • Implantable cardioverter-defibrillator
  • Sudden death
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

Electrophysiologic manifestations of ventricular tachyarrhythmias provoking appropriate defibrillator interventions in high-risk patients with hypertrophic cardiomyopathy. / Cha, Yong-Mei; Gersh, Bernard J.; Maron, Barry J.; Boriani, Giuseppe; Spirito, Paolo; Hodge, David O.; Weivoda, Peggy L.; Trusty, Jane M.; Friedman, Paul Andrew; Hammill, Stephen C.; Rea, Robert F.; Shen, Win Kuang.

In: Journal of Cardiovascular Electrophysiology, Vol. 18, No. 5, 05.2007, p. 483-487.

Research output: Contribution to journalArticle

Cha, Yong-Mei ; Gersh, Bernard J. ; Maron, Barry J. ; Boriani, Giuseppe ; Spirito, Paolo ; Hodge, David O. ; Weivoda, Peggy L. ; Trusty, Jane M. ; Friedman, Paul Andrew ; Hammill, Stephen C. ; Rea, Robert F. ; Shen, Win Kuang. / Electrophysiologic manifestations of ventricular tachyarrhythmias provoking appropriate defibrillator interventions in high-risk patients with hypertrophic cardiomyopathy. In: Journal of Cardiovascular Electrophysiology. 2007 ; Vol. 18, No. 5. pp. 483-487.
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AU - Cha, Yong-Mei

AU - Gersh, Bernard J.

AU - Maron, Barry J.

AU - Boriani, Giuseppe

AU - Spirito, Paolo

AU - Hodge, David O.

AU - Weivoda, Peggy L.

AU - Trusty, Jane M.

AU - Friedman, Paul Andrew

AU - Hammill, Stephen C.

AU - Rea, Robert F.

AU - Shen, Win Kuang

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N2 - Introduction: Our objective was to determine features of ventricular tachyarrhythmias triggering appropriate implantable cardioverter-defibrillator (ICD) interventions in hypertrophic cardiomyopathy (HCM). Methods and Results: The study cohort was 68 high-risk HCM patients who received ICDs for primary sudden cardiac death prevention from 1995 to 2003. All episodes of sustained ventricular tachyarrhythmias identified by stored intracardiac electrograms were analyzed. Nine patients had 51 episodes of sustained ventricular tachyarrhythmic events that required device therapy (mean follow-up, 3.4 ± 2.2 years; cumulative event rate, 3.2% per year): five had 47 episodes of monomorphic ventricular tachycardia (VT); four each had one episode of ventricular fibrillation (VF). Sinus tachycardia or atrial fibrillation was the initiating rhythm in five of nine patients and in 43 of 51 episodes of events. Of the 17 episodes of monomorphic VT detected in the VT zone, 16 (94%) were terminated by antitachycardia pacing. Thirty episodes of monomorphic VT were detected in the VF zone and were terminated by defibrillation. Conclusion: Sustained monomorphic VT is common in a high-risk cohort with HCM. Sinus tachycardia is often the initiating rhythm, suggesting that high sympathetic drive may be proarrhythmic when a susceptible substrate is present. Antitachycardia pacing is highly effective in terminating VT in this patient population.

AB - Introduction: Our objective was to determine features of ventricular tachyarrhythmias triggering appropriate implantable cardioverter-defibrillator (ICD) interventions in hypertrophic cardiomyopathy (HCM). Methods and Results: The study cohort was 68 high-risk HCM patients who received ICDs for primary sudden cardiac death prevention from 1995 to 2003. All episodes of sustained ventricular tachyarrhythmias identified by stored intracardiac electrograms were analyzed. Nine patients had 51 episodes of sustained ventricular tachyarrhythmic events that required device therapy (mean follow-up, 3.4 ± 2.2 years; cumulative event rate, 3.2% per year): five had 47 episodes of monomorphic ventricular tachycardia (VT); four each had one episode of ventricular fibrillation (VF). Sinus tachycardia or atrial fibrillation was the initiating rhythm in five of nine patients and in 43 of 51 episodes of events. Of the 17 episodes of monomorphic VT detected in the VT zone, 16 (94%) were terminated by antitachycardia pacing. Thirty episodes of monomorphic VT were detected in the VF zone and were terminated by defibrillation. Conclusion: Sustained monomorphic VT is common in a high-risk cohort with HCM. Sinus tachycardia is often the initiating rhythm, suggesting that high sympathetic drive may be proarrhythmic when a susceptible substrate is present. Antitachycardia pacing is highly effective in terminating VT in this patient population.

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KW - Hypertrophic cardiomyopathy

KW - Implantable cardioverter-defibrillator

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