1. Appropriate and inappropriate shocks in hypertrophic cardiomyopathy patients with subcutaneous implantable cardioverter-defibrillators: An international multicenter study
- Author
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Babak Nazer, Daniel Jacoby, Paolo Pieragnoli, Andrew Gray, Tuna Ustunkaya, Anjali T. Owens, Nikolaos Papoutsidakis, Stephen B. Heitner, Stacey J. Howell, Zack Dale, Nosheen Reza, Gianmarco Carrassa, Miriam R. Elman, David S. Frankel, Giuseppe Ricciardi, and Iacopo Olivotto
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Sinus tachycardia ,030204 cardiovascular system & hematology ,Global Health ,Risk Assessment ,Sudden death ,Article ,Sudden cardiac death ,Electrocardiography ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Aged ,business.industry ,Incidence ,Incidence (epidemiology) ,Hypertrophic cardiomyopathy ,Odds ratio ,Cardiomyopathy, Hypertrophic ,Middle Aged ,medicine.disease ,Confidence interval ,Defibrillators, Implantable ,Primary Prevention ,Death, Sudden, Cardiac ,Cohort ,Tachycardia, Ventricular ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Subcutaneous implantable cardioverter-defibrillators (S-ICDs) are attractive for preventing sudden cardiac death in hypertrophic cardiomyopathy (HCM) as they mitigate risks of transvenous leads in young patients. However, S-ICDs may be associated with increased inappropriate shock (IAS) in HCM patients. Objective The purpose of this study was to assess the incidence and predictors of appropriate shock and IAS in a contemporary HCM S-ICD cohort. Methods We collected electrocardiographic and clinical data from HCM patients who underwent S-ICD implantation at 4 centers. Etiologies of all S-ICD shocks were adjudicated. We used Firth penalized logistic regression to derive adjusted odds ratios (aORs) for predictors of IAS. Results Eighty-eight HCM patients received S-ICDs (81 for primary and 7 for secondary prevention) with a mean follow-up of 2.7 years. Five patients (5.7%) had 9 IAS episodes (3.8 IAS per 100 patient-years) most often because of sinus tachycardia and/or T-wave oversensing. Independent predictors of IAS were higher 12-lead electrocardiographic R-wave amplitude (aOR 2.55 per 1 mV; 95% confidence interval 1.15–6.38) and abnormal T-wave inversions (aOR 0.16; 95% confidence interval 0.02–0.97). There were 2 appropriate shocks in 7 secondary prevention patients and none in 81 primary prevention patients, despite 96% meeting Enhanced American College of Cardiology/American Heart Association criteria and the mean European HCM Risk-SCD score predicting 5.7% 5-year risk. No patients had sudden death or untreated sustained ventricular arrhythmias. Conclusion In this multicenter HCM S-ICD study, IAS were rare and appropriate shocks confined to secondary prevention patients. The R-wave amplitude increased IAS risk, whereas T-wave inversions were protective. HCM primary prevention implantable cardioverter-defibrillator guidelines overestimated the risk of appropriate shocks in our cohort.
- Published
- 2020