Implantable Cardioverter‐Defibrillator in Patients With Hypertrophic Cardiomyopathy: Efficacy and Complications of the Therapy in Long‐Term Follow‐up

Syska, Paweł; Przybylski, Andrzej; Chojnowska, Lidia; Lewandowski, Michał; Sterliński, Maciej; Maciąg, Aleksander; Gepner, Katarzyna; Pytkowski, Mariusz; Kowalik, Ilona; Mączyńska-Mazuruk, Renata; Rużyłło, Witold; Szwed, Hanna

doi:10.1111/j.1540-8167.2009.01716.x

Cited by 79 publications

(71 citation statements)

References 36 publications

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“…Similarly, inappropriate shocks occurred at a rate of 4.9% (95% CI: 3.9-6.0) per year (I 2 =75%) ( Figure 3). Among six studies (7,8,10,25,29,33), heart transplant was required in 1.6% of patients per year. The annual incidence of lead malfunction and lead displacement was 1.4% (95% CI: 0.8-2.5) and 1.3% (95% CI: 0.8-2.0) respectively.…”

Section: Resultsmentioning

confidence: 99%

“…The incidence of sudden death in HCM is low, around 0.7-1% per annum, and often young patients are affected (2). The use of implantable cardioverter-defibrillator (ICD) protects against SCD secondary to ventricular tachycardia (VT), ventricular fibrillation (VF), or bradycardia, with excellent results (3)(4)(5)(6)(7)(8). A major concern with ICD therapy is the delivery of inappropriate shocks, namely in response to supraventricular tachycardia and atrial fibrillation.…”

Section: Introductionmentioning

confidence: 99%

“…A major concern with ICD therapy is the delivery of inappropriate shocks, namely in response to supraventricular tachycardia and atrial fibrillation. Furthermore, device complications including infection, lead malfunction, and lead displacements pose additional hazards, particularly in a predominantly young patient cohort who require ICD therapy for life (4,5,7,9,10).…”

Section: Introductionmentioning

confidence: 99%

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Implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy: an updated systematic review and meta-analysis of outcomes and complications

Wang¹,

Xie²,

Tjahjono³

et al. 2017

Ann. Cardiothorac. Surg.

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Background: Since the introduction of the implantable cardioverter-defibrillator (ICD) in patients with hypertrophic cardiomyopathy (HCM), the incidence of sudden cardiac death (SCD) has been significantly reduced. Given its widespread use, it is important to identify the outcomes associated with ICD use in patients with HCM. The present paper is a systematic review and meta-analysis of the rates of appropriate and inappropriate interventions, mortality, and device complications in HCM patients with an ICD.Methods: We conducted a systematic review and meta-analysis on 27 studies reporting outcomes and complications after ICD implantation in patients with HCM. ICD interventions, device complications, and mortality were extracted for analysis.Results: A total of 3,797 patients with HCM and ICD implantation were included (mean age, 44.5 years; 63% male), of which 83% of patients had an ICD for primary prevention of SCD. The cardiac mortality was 0.9% (95% CI: 0.7-1.3) per year and non-cardiac mortality was 0.8% (95% CI: 0.6-1.2) per year. Annualized appropriate intervention rate was 4.8% and annualized inappropriate intervention was 4.9%. The annual incidence of lead malfunction, lead displacement and infection was 1.4%, 1.3%, and 1.1%, respectively.Conclusions: ICD use in patients with HCM produces low rates of cardiac and non-cardiac mortality, and an appropriate intervention rate of 4.8% per year. However, moderate rates of inappropriate intervention and device complications warrant careful patient selection in order to optimize the risk to benefit ratio in this select group of patients.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy: an updated systematic review and meta-analysis of outcomes and complications

Wang¹,

Xie²,

Tjahjono³

et al. 2017

Ann. Cardiothorac. Surg.

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“…Hence, the summary estimate of clinical data and outcome is based on 16 studies. 4,7,9,[12][13][14]16,[18][19][20][24][25][26][27][28]30 Thirteen (81%) studies reported on a population of patients with HCM with an ICD for primary or secondary prevention of SCD, 1 (8%) study focused on patients with HCM with an ICD for primary prevention of SCD, and 2 (13%) studies reported on patients with hypertrophic obstructive cardiomyopathy who underwent alcohol septal ablation and had received an ICD.…”

Section: Search Resultsmentioning

confidence: 99%

Outcome and Complications After Implantable Cardioverter Defibrillator Therapy in Hypertrophic Cardiomyopathy

Schinkel

Vriesendorp

Sijbrands

et al. 2012

Circ: Heart Failure

151

125

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P atients with hypertrophic cardiomyopathy (HCM) are at increased risk for sudden cardiac death (SCD), mostly caused by ventricular arrhythmias. SCD may occur as the initial presentation of HCM, often in asymptomatic or mildly symptomatic patients. 1 In fact, HCM is the most frequent cause of SCD in young people, including trained athletes. 2,3 Implantable cardioverter defibrillator (ICD) therapy may effectively terminate potentially life-threatening ventricular arrhythmias, thereby preventing SCD and prolonging life. Still, ICD therapy is not without risk, because inappropriate interventions and device-related complications may occur. Clinical Perspective on p 559Previous observational studies have reported on the use of ICD therapy for primary and secondary preventions of SCD in HCM. A complete overview of outcome and complications after ICD therapy in patients with HCM at risk for SCD is currently not available. The goal of this analysis was to pool the individual studies in an effort to examine the precise rate of cardiac and noncardiac mortality, appropriate and inappropriate interventions, and complications. This knowledge may aid clinical decision making and counseling in patients with HCM at increased risk for SCD considered for ICD therapy. Methods Study DesignThis systematic review and meta-analysis included all available original studies reporting clinical outcome and complications in patients with HCM who underwent ICD implantation. Studies that did not provide data on outcome or complications and review manuscripts were excluded. Studies focussing on SCD in patients with HCM without ICD were excluded. Literature SearchThe online MEDLINE database was searched for literature in Background-Previous observational studies demonstrated that patients with hypertrophic cardiomyopathy at risk for sudden cardiac death (SCD) may benefit from implantable cardioverter defibrillator (ICD) therapy. A complete overview of outcome and complications after ICD therapy is currently not available. This study pools data from published studies on outcome and complications after ICD therapy in patients with hypertrophic cardiomyopathy. Methods and Results-A PubMed database search returned 27 studies on 16 cohorts reporting outcome and complications after ICD therapy in patients with hypertrophic cardiomyopathy. In case of >1 publications on a particular cohort, the publication with the largest number of patients was included in the meta-analysis. ICD interventions, complications, and mortality rates were extracted, pooled, and analyzed. There were 2190 patients (mean age, 42 years; 38% women), most of whom (83%) received an ICD for primary prevention of SCD. Risk factors for SCD were left ventricular wall thickness ≥30 mm (20%), family history of SCD (43%), nonsustained ventricular tachycardia (46%), syncope (41%), and abnormal blood pressure response (25%). During the 3.7-year follow-up, the annualized cardiac mortality rate was 0.6%, the noncardiac mortality rate was 0.4%, and the appropriate ICD intervention rate was 3...

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“…The central role of ventricular arrhythmias in the pathogenesis of SCD in HCM is supported by the observation that HCM patients treated with ICD receive appropriate therapies. [10][11][12][13][14][15][16][17][18] Systematic analysis of stored electrograms shows that the majority of ventricular arrhythmias occur while in normal sinus rhythm and are precipitated by premature ventricular complexes. 19 In addition, data from chance electrocardiographic recordings have shown that ventricular fibrillation can be precipitated by runs of ventricular tachycardia, rapid atrial fibrillation (AF), or accelerated atrioventricular conduction.…”

Section: Sudden Cardiac Death and Underlying Mechanismsmentioning

confidence: 99%

Sudden Cardiac Death in Hypertrophic Cardiomyopathy

O’Mahony

Elliott

McKenna

2013

Circ: Arrhythmia and Electrophysiology

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SCD in HCM has been linked with physical exertion. 33 A vicious cycle of increasing myocardial ischemia, caused by diastolic dysfunction, LVOTO, systemic hypotension, and decreased stroke volume, has been suggested, but SCD can occur at rest or sleep, 33 when metabolic demands are low. The exact triggers of ventricular arrhythmias remain unclear. Risk Factors of SCD in HCMVarious phenotypic characteristics have been linked with SCD and are currently used to identify patients at risk. 34,35 These risk factors were first noted in small, comparative observational studies, and then re-examined in larger studies with multivariable survival analysis using the Cox proportional

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Implantable Cardioverter‐Defibrillator in Patients With Hypertrophic Cardiomyopathy: Efficacy and Complications of the Therapy in Long‐Term Follow‐up

Cited by 79 publications

References 36 publications

Implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy: an updated systematic review and meta-analysis of outcomes and complications

Implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy: an updated systematic review and meta-analysis of outcomes and complications

Outcome and Complications After Implantable Cardioverter Defibrillator Therapy in Hypertrophic Cardiomyopathy

Sudden Cardiac Death in Hypertrophic Cardiomyopathy

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