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. 2025 Oct 21;14(20):7432.
doi: 10.3390/jcm14207432.

Extended ECG Monitoring in Patients with Hypertrophic Cardiomyopathy: The Tempo-HCM Study

Juan Caro-Codón  1 , Sergio Castrejón  1 , Rosalía Cadenas  2 , Carlos Casanova  2 , Andrea Vélez  2 , Mayte Basurte  3 , Gemma Lacuey  3 , Vicente Climent  4 , Óscar Salvador  5 , Andrea Severo-Sánchez  6 , Luis Fernández  7 , Esther Pérez-David  1 , Rafael Peinado  1 , Silvia Valbuena-López  1 , Gabriela Guzmán  1 , Álvaro Jiménez-Mas  5 , Raúl Moreno  1 , Jose L Merino  1
Affiliations

Extended ECG Monitoring in Patients with Hypertrophic Cardiomyopathy: The Tempo-HCM Study

Juan Caro-Codón et al. J Clin Med. .

Abstract

Background/Objectives: Current guidelines recommend 24-48 h Holter for risk stratification and atrial fibrillation (AF) screening in hypertrophic cardiomyopathy (HCM). However, the limited duration of this approach may not provide optimal sensitivity. In addition, extended ECG monitoring has been demonstrated to be more effective in detecting arrhythmias in other clinical entities. We aimed to assess the utility of extended ECG monitoring for 30 days in a non-high-risk cohort of HCM patients. Methods: We conducted a prospective multicentre study with 113 non-high-risk HCM patients who underwent 30-day ECG monitoring with a dedicated device. We compared the detection of relevant arrhythmias (AF, atrial flutter, and non-sustained ventricular tachycardia) during 30-day monitoring with the findings observed during the first 24 h. Results: Extended ECG monitoring detected relevant arrhythmias in 63.7% of patients, compared with 12.4% during the first 24 h (p < 0.001). This difference was mainly driven by non-sustained ventricular tachycardia (NSVT) (61.1% vs. 8.9%, p < 0.001). Atrial fibrillation episodes were detected in 10.6% of patients after completing prolonged monitoring vs. 6.2% during the first 24 h (p = 0.066). Extended monitoring resulted in a reclassification of 21.2% of patients to a higher sudden cardiac death (SCD) risk category using the HCM-SCD calculator. Conclusions: Extended ECG monitoring significantly enhances the detection of arrhythmias in HCM. Using this technique, NSVT were detected in most patients of a non-high-risk HCM cohort. Further investigation is warranted to determine the role of extended monitoring in SCD risk stratification and AF screening.

Keywords: atrial fibrillation; electrocardiographic monitoring; hypertrophic cardiomyopathy; non-sustained ventricular tachycardia; risk stratification; sudden cardiac death.

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Conflict of interest statement

Dr. Peinado reports research grants (Medtronic, Abbot) and a fellowship training program grant (Boston Scientific). Dr. Merino reports research contracts (Abbot, Boston Scientific, Medtronic), advisory boards (Sanofi) and educational contracts (Abbot, Microport). All other authors report no conflict of interest.

Figures

Figure 1
Figure 1
Panel (A) shows the prevalence of a composite outcome of NSVT and AF after 24 h and 30 days of monitoring. Panel (B) shows the prevalence of NSVT and AF separately.
Figure 2
Figure 2
Illustrative findings in two patients after extended monitoring. Panels (A,B) were obtained from a patient with four episodes of fast NSVT well beyond 24–48 h of monitoring (at days 9, 15, 20 and 28). Panels (C,D) illustrate another patient with a new diagnosis of paroxysmal AF in day 14.
Figure 3
Figure 3
Kaplan–Meier survival analysis for the incidence of NSVT during extended monitoring.
Figure 4
Figure 4
Sensitivity analysis of the HCM-SCD calculator incorporating findings from 30-day monitoring.
Figure 5
Figure 5
Prevalence and characteristics of AF episodes detected after 24 h and 30 days monitoring.
See this image and copyright information in PMC

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