Implantable Cardioverter Defibrillator and Hypertrophic Cardiomyopathy. Experience at Three Centers

• Published in: Revista española de cardiología (English ed.) 2006-06, Vol.59 (6), p.537-544
• Main Authors: Marín, Francisco, Gimeno, Juan R., Payá, Eduardo, García-Alberola, Arcadio, Pérez-Álvarez, Luisa, Fernández, Xusto, de la Morena, Gonzalo, Sogorb, Francisco, Castro-Beiras, Alfonso, Valdés, Mariano, Martínez, Juan G., Monserrat, Lorenzo
• Format: Article
• Language: English
• Subjects: Desfibrilador automático implantable; Hypertrophic cardiomyopathy; Implantable cardioverter-defibrillator; Miocardiopatía hipertrófica; Muerte súbita; Sudden death
• ISSN: 1885-5857; 1885-5857
• DOI: 10.1016/S1885-5857(07)60004-8

Although implantable cardioverter-defibrillators (ICDs) are recommended for high-risk patients with hypertrophic cardiomyopathy (HCM), there is no agreement on their general use. Moreover, little information is available on ICD use in this setting in Spain. Our aims were to describe the characteristics of HCM patients who received ICDs at three hospitals in Spain, and to study indications for device implantation and the results of follow-up in device users. We evaluated risk factors for sudden death in HCM patients with ICDs, including family history of sudden death, recurrent syncope, maximum wall thickness >30 mm, left ventricular outflow pressure gradient >30 mm Hg, abnormal blood pressure response to exercise, and nonsustained ventricular tachycardia. During regular follow-up, appropriate and inappropriate administration of ICD therapy was recorded. Of 726 HCM patients, 45 (6.2%) had an ICD (mean age 43 [20] years). The proportion of patients with ICDs at the three centers studied was highly variable despite patients' clinical characteristics being similar. The indication for implantation was primary prevention in 27 patients and secondary prevention in 18. During follow-up (median 32 months), ICD therapy was administered appropriately in 10 (22.0%) patients (in 9, as secondary prevention and, in 1, as primary prevention). The annual appropriate ICD therapy rate was 11.1% for secondary prevention and 1.6% for primary prevention. Two patients received an ICD to treat ventricular fibrillation and 8, to treat sustained ventricular tachycardia. The only significant predictor of appropriate ICD therapy was a history of sustained ventricular tachycardia or ventricular fibrillation (hazard ratio =13.3, P=.014). The percentage of HCM patients undergoing ICD implantation at Spanish hospitals was highly variable, possibly due to different selection criteria. When used as secondary prevention, ICD therapy was administered appropriately in a high proportion of cases (50% in 3 years). El desfibrilador automático implantable (DAI) es el tratamiento recomendado en la miocardiopatía hipertrófica (MCH) de alto riesgo, aunque no hay acuerdo en sus indicaciones. Hay pocos datos so-bre su utilización en nuestro país. El objetivo es describir las características de los pacientes con MCH a los que se les implantó un DAI y analizar los resultados de esta tera-pia. Se analizaron los factores de riesgo de muerte súbita en los pacientes portadores de DAI de 3 centros con consul