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Risk assessment for primary prophylactic ICD implantation in hypertrophic cardiomyopathy using the risk calculator: discrepancy between theory and clinical practice?

Session Clinical Case Corner 1

Speaker Thomas Kleemann

Event : EHRA 2018

  • Topic : arrhythmias and device therapy
  • Sub-topic : Ventricular Arrhythmias and SCD - Clinical
  • Session type : Poster Session

Authors : T Kleemann (Ludwigshafen,DE), M Strauss (Ludwigshafen,DE), K Kouraki (Ludwigshafen,DE), N Werner (Ludwigshafen,DE), R Zahn (Ludwigshafen,DE)

Authors:
T Kleemann1 , M Strauss1 , K Kouraki1 , N Werner1 , R Zahn1 , 1Medizinische Klinik B, Klinikum Ludwigshafen - Ludwigshafen - Germany ,

Citation:
European Heart Journal Supplements ( 2018 ) 20 ( Supplement 1 ), i92

Background: In hypertrophic cardiomyopathy (HCM) ESC guidelines recommend the use of a risk calculator to assess the risk of sudden cardiac death (SCD). Aim of the study was to compare the calculated risk of SCD at baseline in HCM patients with the incidence of malignant ventricular arrhythmias during follow-up. Methods and results: A total of 27 of 2017 (1.3%) patients of the prospective single-centre ICD-registry Ludwigshafen had a HCM and underwent primary prophylactic ICD implantation. Patients were stratified according to the risk score into a low, intermediate and high risk group (Table 1). During the median follow-up time of 4.5 years 8 patients had ICD shocks triggered by ventricular arrhythmias (VT/VF).

Kaplan-Meier curves showed no difference of event-free survival between the low, intermediate and high risk groups.

Conclusions: In patients with HCM stratified according to the HCM risk score the incidence of VA was not different between the different risk groups. Even in the low risk group where ICD is not generally recommended almost half of the patients had a VT/VF shock during the 5-year follow-up.

Low risk

(n = 13)

Intermediate risk (n = 9)

High risk

(n = 5)

Age (years)

66 (47; 71)

57 (49; 63)

43 (29; 64)

Female

31%

33%

60%.

Risk score

2.47

4.43

9.32

Maximum LV wall thickness (mm)

17 (14; 18)

20 (18; 23)

16 (13; 24)

Left atrial diameter

45 (44; 50)

50 (43; 52)

44 (38; 50)

LVOT gradient (mmHg)

9 ±19

33 ± 30

66 ± 109

Syncope

8%

44%

100%.

Non-sustained VT

54%

56%

80%

Appropriate ICD shock during FU

46%

11%

20%

All-cause mortality

23%

11%

0%

Baseline characteristics and outcome of ICD patients stratified according to the calculated risk score.


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