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

Abstract

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.

Effectiveness of the 2014 European Society of Cardiology guideline on sudden cardiac death in hypertrophic cardiomyopathy: a systematic review and meta-analysis

“…The effectiveness of ICD in preventing SCD in HCM is well established but frequent device complications27 make risk stratification a crucial step in the management of all patients. Historically, SCD risk has been estimated by evaluating clinical parameters which reflect the severity of the underlying myocardial disease.…”

Patient understanding of disease and the use and outcome of implantable cardioverter defibrillators in hypertrophic cardiomyopathy

“…Although modern ICD technologies have reduced device malfunction, especially inappropriate shocks, it remains one of the most frequent complications among those requiring ICD due to HCM . Recent systematic review and expert opinion demonstrates a rate of 4.9% per year of inappropriate shocks in comparison to 4.8% per year of appropriate shocks …”

Hypertrophic cardiomyopathy: current state of the problem

“…По данным системного обзора и метаанализа N. Wang и соавт. [14], включившего 27 исследований (n=3797), частота «ложных» срабатываний ИКД у пациентов с ГКМП остается высокой (4,8% адекватных против 4,9% неадекватных срабатываний в год). Данный факт указывает на необходимость тщательного отбора пациентов для имплантации дан-ного устройства.…”