Evidence That Pharmacological Strategies Lack Efficacy for the Prevention of Sudden Death in Hypertrophic Cardiomyopathy

Overview

Journal Heart

Date 2007 May 16

PMID 17502652

Citations 25

Authors

P Melacini

B J Maron

F Bobbo

C Basso

B Tokajuk

M Zucchetto

G Thiene

S Iliceto

Affiliations

Soon will be listed here.

Abstract

Objective: To determine the efficacy of pharmacological treatment in the prevention of sudden cardiac death in hypertrophic cardiomyopathy (HCM).

Design: Clinical outcome was assessed retrospectively in 293 patients with HCM, including 173 who were taking cardioactive medications.

Setting: Department of Cardiology, University of Padua, Padua, Italy; a tertiary HCM Centre.

Interventions: Medical treatment with beta blockers, verapamil, sotalol and amiodarone.

Main Outcome Measure: HCM-related sudden cardiac death.

Results: 17 of 173 (10%) patients died suddenly or had aborted cardiac arrest, while being treated continuously with drugs having antiarrhythmic properties, over a period of 62 (56) months. Sudden death occurred in 20% of patients administered amiodarone (6/30), 9% each of patients taking verapamil (4/46) or beta blockers (7/76), and 0% of those taking sotalol (0/21). Patients taking cardioactive drugs (n = 173) and those without pharmaceutical therapy (n = 120) did not differ with respect to sudden death mortality.

Conclusion: Medical treatment is not absolutely protective against the risk of sudden death in HCM. The present data inferentially support the use of the implantable defibrillator as the primary treatment choice for prevention of sudden death in high-risk patients with HCM.

Citing Articles

Cardiomyopathy and Sudden Cardiac Death: Bridging Clinical Practice with Cutting-Edge Research.

Mistrulli R, Ferrera A, Salerno L, Vannini F, Guida L, Corradetti S Biomedicines. 2024; 12(7).

PMID: 39062175 PMC: 11275154. DOI: 10.3390/biomedicines12071602.

The new European Society of Cardiology guideline for the management of cardiomyopathies: key messages for cardiac electrophysiologists.

Korthals D, Eckardt L Herzschrittmacherther Elektrophysiol. 2023; 34(4):311-323.

PMID: 37973628 PMC: 10682323. DOI: 10.1007/s00399-023-00975-y.

Ventricular arrhythmia management in patients with genetic cardiomyopathies.

Sharif Z, Lubitz S Heart Rhythm O2. 2022; 2(6Part B):819-831.

PMID: 34988533 PMC: 8710624. DOI: 10.1016/j.hroo.2021.10.009.

The Arrhythmic Phenotype in Cardiomyopathy.

Merlo M, Grilli G, Cappelletto C, Mase M, Porcari A, Dal Ferro M Heart Fail Clin. 2021; 18(1):101-113.

PMID: 34776072 PMC: 11744940. DOI: 10.1016/j.hfc.2021.07.011.

Targeted Medical Therapies for Hypertrophic Cardiomyopathy.

Fumagalli C, De Gregorio M, Zampieri M, Fedele E, Tomberli A, Chiriatti C Curr Cardiol Rep. 2020; 22(2):10.

PMID: 31993794 DOI: 10.1007/s11886-020-1258-x.

References

McKenna W, Behr E . Hypertrophic cardiomyopathy: management, risk stratification, and prevention of sudden death. Heart. 2002; 87(2):169-76. PMC: 1767009. DOI: 10.1136/heart.87.2.169. View

Maron B . Hypertrophic cardiomyopathy: a systematic review. JAMA. 2002; 287(10):1308-20. DOI: 10.1001/jama.287.10.1308. View

Maron B, Estes 3rd N, Maron M, Almquist A, Link M, Udelson J . Primary prevention of sudden death as a novel treatment strategy in hypertrophic cardiomyopathy. Circulation. 2003; 107(23):2872-5. DOI: 10.1161/01.CIR.0000072343.81530.75. View

Maron B, McKenna W, Danielson G, Kappenberger L, Kuhn H, Seidman C . American College of Cardiology/European Society of Cardiology clinical expert consensus document on hypertrophic cardiomyopathy. A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the.... J Am Coll Cardiol. 2003; 42(9):1687-713. DOI: 10.1016/s0735-1097(03)00941-0. View

Jayatilleke I, Doolan A, Ingles J, McGuire M, Booth V, Richmond D . Long-term follow-up of implantable cardioverter defibrillator therapy for hypertrophic cardiomyopathy. Am J Cardiol. 2004; 93(9):1192-4. DOI: 10.1016/j.amjcard.2004.01.057. View

Elliott P, McKenna W . Hypertrophic cardiomyopathy. Lancet. 2004; 363(9424):1881-91. DOI: 10.1016/S0140-6736(04)16358-7. View

Elliott P, Poloniecki J, Dickie S, Sharma S, Monserrat L, Varnava A . Sudden death in hypertrophic cardiomyopathy: identification of high risk patients. J Am Coll Cardiol. 2000; 36(7):2212-8. DOI: 10.1016/s0735-1097(00)01003-2. View

Cecchi F, Olivotto I, Montereggi A, Squillatini G, Dolara A, Maron B . Prognostic value of non-sustained ventricular tachycardia and the potential role of amiodarone treatment in hypertrophic cardiomyopathy: assessment in an unselected non-referral based patient population. Heart. 1998; 79(4):331-6. PMC: 1728662. DOI: 10.1136/hrt.79.4.331. View

Pacifico A, Hohnloser S, Williams J, Tao B, Saksena S, Henry P . Prevention of implantable-defibrillator shocks by treatment with sotalol. d,l-Sotalol Implantable Cardioverter-Defibrillator Study Group. N Engl J Med. 1999; 340(24):1855-62. DOI: 10.1056/NEJM199906173402402. View

10.

Ostman-Smith I, Wettrell G, Riesenfeld T . A cohort study of childhood hypertrophic cardiomyopathy: improved survival following high-dose beta-adrenoceptor antagonist treatment. J Am Coll Cardiol. 1999; 34(6):1813-22. DOI: 10.1016/s0735-1097(99)00421-0. View

11.

Maron B, Shen W, Link M, EPSTEIN A, Almquist A, Daubert J . Efficacy of implantable cardioverter-defibrillators for the prevention of sudden death in patients with hypertrophic cardiomyopathy. N Engl J Med. 2000; 342(6):365-73. DOI: 10.1056/NEJM200002103420601. View

12.

Maron B, Olivotto I, Spirito P, Casey S, BELLONE P, Gohman T . Epidemiology of hypertrophic cardiomyopathy-related death: revisited in a large non-referral-based patient population. Circulation. 2000; 102(8):858-64. DOI: 10.1161/01.cir.102.8.858. View

13.

McKenna W, Oakley C, Krikler D, Goodwin J . Improved survival with amiodarone in patients with hypertrophic cardiomyopathy and ventricular tachycardia. Br Heart J. 1985; 53(4):412-6. PMC: 481782. DOI: 10.1136/hrt.53.4.412. View