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  • Title: Determinants of implantable defibrillator discharges in high-risk patients with hypertrophic cardiomyopathy.
    Author: Woo A, Monakier D, Harris L, Hill A, Shah P, Wigle ED, Rakowski H, Rozenblyum E, Cameron DA.
    Journal: Heart; 2007 Sep; 93(9):1044-5. PubMed ID: 17699173.
    Abstract:
    OBJECTIVES: To identify the determinants of appropriate and inappropriate implantable cardioverter-defibrillator (ICD) discharges in patients with hypertrophic cardiomyopathy (HCM). DESIGN: Retrospective cohort study. SETTING: ICD clinic at an academic hospital. PATIENTS: 61 patients with HCM who received ICDs for the primary or secondary prevention of sudden cardiac death (SCD). OUTCOME MEASURES: (a) Analysis of appropriate and inappropriate ICD discharges; (b) predictors of ICD discharges. RESULTS: Mean (SD) age at ICD insertion was 46 (18) years (range 10-79). Follow-up time was 40 (27) months (range 7-151). Eight patients experienced an appropriate discharge, occurring 24.5 (13.6) months after ICD insertion. Appropriate ICD intervention was more common in the secondary (36%) than the primary (8%) prevention group (p = 0.02). Inappropriate ICD discharges occurred in 20 (33%) patients. Multivariate Cox regression analysis identified two significant predictors of inappropriate ICD discharges: (a) age <30 years at the time of ICD insertion (hazard ratio (HR) = 3.0 (95% CI 1.1 to 8.0; p = 0.03) and (b) history of atrial fibrillation (HR = 3.1 (95% CI 1.2 to 8.1; p = 0.02). CONCLUSIONS: ICDs are effective in the prevention of SCD in HCM. However, there is a high incidence of inappropriate ICD discharges.
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