Circulation, Vol 90, 2743-2747, Copyright © 1994 by American Heart Association
P Spirito, C Rapezzi, C Autore, P Bruzzi, P Bellone, P Ortolani, PV Fragola, F Chiarella, M Zoni-Berisso and A Branzi
BACKGROUND: In the early 1980s, studies performed in highly selected
referral patients with hypertrophic cardiomyopathy reported a strong
association between the presence of brief episodes of ventricular
tachycardia (VT) on ambulatory ECG monitoring and sudden death. These
observations led to antiarrhythmic treatment in many patients with
hypertrophic cardiomyopathy and brief episodes of VT. In recent years,
however, a growing awareness of the potential arrhythmogenic effects of
antiarrhythmic medications has raised doubts regarding such a therapeutic
approach, particularly in less selected and lower-risk patient populations.
METHODS AND RESULTS: In the present study, we examined the prognostic
significance of nonsustained VT in a population of 151 patients with
hypertrophic cardiomyopathy who were asymptomatic or had only mild symptoms
at the time of their initial ambulatory ECG recording. Of the 151 study
patients, 42 had episodes of VT and 109 did not. The runs of VT ranged from
3 to 19 beats, with 35 patients (83%) having < 10 beats. The number of
runs of VT ranged from 1 to 12 in 24 hours, with 36 patients (86%) having
< or = 5 episodes of VT. Thus, in most patients, the episodes of VT were
brief and infrequent. Follow-up averaged 4.8 years. Of the 151 study
patients, 6 died suddenly, 3 in the group with VT and 3 in the group
without VT. Two other patients, both in the group without VT, died of
congestive heart failure. The total cardiac mortality rate was 1.4% per
year in the patients with VT (95% CI, 0.4% to 3.5%) and 0.9% in those
without VT (95% CI, 0.4% to 2.0%; P = .43). The relative risk of cardiac
death for patients with VT was 1.4 compared with patients without VT (95%
CI, 0.6 to 6.1). The sudden death rate was 1.4% per year in the patients
with VT (95% CI, 0.4% to 3.5%) and 0.6% in those without VT (95% CI, 0.2%
to 1.5%; P = .24). The relative risk of sudden death for patients with VT
compared with those without VT was 2.4 (95% CI, 0.5 to 11.9). Of the 151
patients included in the study, 88 (58%) remained asymptomatic and were not
treated with cardioactive medications during follow-up. Of these 88
patients, 20 were in the group with VT and 68 in the group without VT. None
of these patients died. CONCLUSIONS: Our results show that cardiac
mortality is low in patients with hypertrophic cardiomyopathy who are
asymptomatic or only mildly symptomatic and have brief and infrequent
episodes of VT on ambulatory ECG monitoring. Our findings also suggest that
brief and infrequent episodes of VT should not be considered, per se, an
indication for antiarrhythmic treatment in such patients.
ARTICLES
Prognosis of asymptomatic patients with hypertrophic cardiomyopathy and nonsustained ventricular tachycardia
Divisione di Cardiologia, Ente Ospedaliero Ospedali Galliera, Genoa, Italy.
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