Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug;68(8):1059-1063.
doi: 10.1590/1806-9282.20220199.

ICD indication in hypertrophic cardiomyopathy: which algorithm to use?

Marcelo Antônio Oliveira Santos-Veloso  1   2 , Ândrea Virgínia Ferreira Chaves  1   2   3 , Eveline Barros Calado  4 , Manuel Markman  5 , Lucas Soares Bezerra  1   2 , Sandro Gonçalves de Lima  2   4 , Brivaldo Markman Filho  4 , Dinaldo Cavalcanti de Oliveira  1
Affiliations

ICD indication in hypertrophic cardiomyopathy: which algorithm to use?

Marcelo Antônio Oliveira Santos-Veloso et al. Rev Assoc Med Bras (1992). 2022 Aug.

Abstract

Objective: This study aimed to evaluate the agreement in the indication of implantable cardioverter-defibrillators in patients with Hypertrophic cardiomyopathy, as per the 2014 European Society of Cardiology and 2020 American Heart Association recommendations, and evaluate fragmented QRS as a predictor of cardiovascular outcome.

Methods: Retrospective cohort with 81 patients was evaluated between 2019 and 2021. Patients with hypertrophic cardiomyopathy ≥16 years old were included. Exclusion criteria include secondary myocardiopathy and follow-up <1 year. Kappa coefficient was used to determine the agreement. Survival and incidence curves were determined by Kaplan-Meier method. A p<0.05 was considered significant.

Results: The fragmented QRS was identified in 44.4% of patients. There were no differences between patients with and without fragmented QRS regarding clinical parameters, echocardiography, fibrosis, and sudden cardiac death risk. During follow-up of 4.8±3.4 years, there was no sudden cardiac death, but 20.6% patients with implantable cardioverter-defibrillator had at least one appropriate shock. Three of the seven appropriate shocks occurred in European Society of Cardiology low- to moderate-risk patients. Three shocks occurred in moderate-risk patients and four in American Heart Association high-risk patients. Overall recommendations agreement was 64% with a kappa of 0.270 (p=0.007). C-statistic showed no differences regarding the incidence of appropriate shock (p=0.644).

Conclusion: sudden cardiac death risk stratification algorithms present discrepancies in implantable cardioverter-defibrillator indication, both with low accuracy.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: the authors declare there is no conflicts of interest.

Figures

Figure 1
Figure 1. Survival and incidence curves for the primary outcome and appropriate shocks.
Figure 2
Figure 2. Receiver operating characteristic curve comparing the incidence of appropriate shocks according to European Society of Cardiology 2014 and American Heart Association 2020 guidelines implantable cardioverter-defibrillator indication.
See this image and copyright information in PMC

References

    1. Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, et al. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: a report of the American college of cardiology/American heart association joint committee on clinical practice guidelines. Circulation. 2020;142(25):e558–e631. doi: 10.1161/CIR.0000000000000937. - DOI - PubMed
    1. Maron BJ, Maron MS. Hypertrophic cardiomyopathy. Lancet. 2013;381(9862):242–255. doi: 10.1016/S0140-6736(12)60397-3. - DOI - PubMed
    1. Adamczak DM, Oko-Sarnowska Z. Sudden cardiac death in hypertrophic cardiomyopathy. Cardiol Rev. 2018;26(3):145–151. doi: 10.1097/CRD.0000000000000184. - DOI - PubMed
    1. Authors/Task Force members. Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC) 2014;35(39):2733–2779. doi: 10.1093/eurheartj/ehu284. - DOI - PubMed
    1. Mattos BPE, Scolari FL, Garbin HI. Discrepancy between International Guidelines on the Criteria for Primary Prevention of Sudden Cardiac Death in Hypertrophic Cardiomyopathy. Arq Bras Cardiol. 2020;115(2):197–204. doi: 10.36660/abc.20190161. - DOI - PMC - PubMed

MeSH terms