TORNA ALL’ELENCO

Performance of sudden cardiac death risk score at the time of device replacement for patients with hypertrophic cardiomyopathy in Heart Rhythm

2017
AO Cuneo

Tipo pubblicazione

Conference Abstract

Autori/Collaboratori (20)Vedi tutti...

Biffi M

Ammendola E

Ferrari P


et alii...

Abstract

Background: Recent ESC/AHA guidelines have modified the risk scoring system for ICD implantation in hypertrophic cardiomyopathy. An appropriate risk stratification may be relevant also at the end of ICD battery life when the decision to replace the device must be taken. Objective: At the present time, no data are available from HCM patients who undergo an ICD replacement procedure. We evaluated the current ESC risk score to predict SD risk over 5 years in our population Methods: Data from 38 pts with HCM from the DECODE registry were included in the present analysis. The SD risk score suggests: recommendation for ICD implant if SD risk ?6% (high risk profile - HRp); implantation of ICD is based on physician discretion if SD risk is between 4% and 6% (intermediate risk profile - IRp); ICD is not-recommended if SD is < 4% (low risk profile - LRp). Decision on first ICD implantation was based on reference guidelines. Results: The median SDrs was 6.9 [3.8-11.6]: 11 (29%) pts had a SDrs < 4%; 3 (8%) pts had an intermediate SDrs and 24 (63%) pts had a HRp. Pts characteristics at the time of ICD replacement were: mean age = 56±16 years; male gender = 26 (68.4%); history of AF = 19 (50%); median LVEF = 55% [40.25-69.5] and NYHA class I = 20 (52.6%). 16 (42.1%) pts experienced an appropriate ICD therapy whereas 6 (15.8%) pts received an inappropriate ICD therapy before ICD replacement over a mean follow-up period of 5.6±2 years. No differences were found in terms of appropriate therapy among pts with a HRp and IRp to LRp: 11/24 (46%) pts for HRp group vs 5/14 (36%) pts for IRp/LRp group (p=NS). After ICD replacement 5 (13.2%) pts experienced an appropriate ICD therapy whereas 2 (5.3%) pts received an inappropriate ICD therapy over a mean follow-up period of 378±69 days, all in the HRp group. Conclusion: The current risk stratification tool for identifying patients with HCM indicated to ICD may exclude pts who are prone to receive life-threatening VT during ICD se

Keywords

endogenous compound; adult; clinical article; controlled study; female; follow up; gender; heart left ventricle ejection fraction; human; hypertrophic cardiomyopathy; implant; male; middle aged; New York Heart Association class; physician; population model; practice guideline; register; stratification; sudden cardiac death;