PMID- 21757459
OWN - NLM
STAT- MEDLINE
DCOM- 20120502
LR  - 20111214
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Linking)
VI  - 98
IP  - 2
DP  - 2012 Jan
TI  - The long-term survival and the risks and benefits of implantable cardioverter 
      defibrillators in patients with hypertrophic cardiomyopathy.
PG  - 116-25
LID - 10.1136/hrt.2010.217182 [doi]
AB  - OBJECTIVE: Implantable cardioverter defibrillators (ICDs) are routinely used to 
      prevent sudden cardiac death (SCD) in selected hypertrophic cardiomyopathy (HCM) 
      patients, but the determinants of device-related complications, therapies and 
      long-term cardiovascular mortality in ICD recipients are not known. DESIGN: 
      Retrospective observational cohort study. SETTING: Single-centre tertiary 
      referral cardiomyopathy clinic. Patients 334 consecutively evaluated HCM patients 
      (median age 40 years, 62% male, 92% primary prevention) at risk of SCD treated 
      with ICD. Thirty-six patients (11%) received concurrent cardiac resynchronisation 
      therapy for heart failure symptoms. RESULTS: During the 1286 patient-years of 
      follow-up, cardiovascular mortality (including transplantation) occurred in 22 
      (7%) patients (1.7%/year) and was associated with New York Heart Association 
      (NYHA) class III/IV (adjusted HR=9.38, 95% CI 3.31 to 26.55, p</=0.001), percentage 
      fractional shortening (HR=0.92, 95% CI 0.87 to 0.96, p=0.001) and implantation 
      for secondary prevention (HR=0.07, 95% CI 0.01 to 0.86, p=0.04). There were no 
      SCD. Twenty-eight (8%) patients received appropriate shocks (2.3%/year), which 
      were predicted by baseline fractional shortening (HR=0.96, 95% CI 0.92 to 0.99, 
      p=0.04). Fifty-five (16%) patients received inappropriate shocks (4.6%/year). 
      Sixty (18%) patients experienced implant-related complications (5.1%/year), 
      including two deaths. Adverse ICD-related events (inappropriate shocks and/or 
      implant complications) were seen in 101 (30%) patients (8.6%/year). Patients with 
      cardiac resynchronisation therapy were more likely to develop implant 
      complications than those with single-chamber ICDs (HR=4.39, 95% CI 1.44 to 13.35, 
      p=0.009) and had a higher 5-year cardiovascular mortality than did the rest of 
      the cohort (21% vs 6%, p<0.001). CONCLUSIONS: HCM patients with an ICD have a 
      significant cardiovascular mortality and are exposed to frequent inappropriate 
      shocks and implant complications. These data suggest that new strategies are 
      required to improve patient selection for ICDs and to prevent disease progression 
      in those that receive a device.
FAU - O'Mahony, Constantinos
AU  - O'Mahony C
AD  - The Heart Hospital, 16-18 Westmoreland Street, London, UK. 
      perry.elliott@ucl.ac.uk
FAU - Lambiase, Pier D
AU  - Lambiase PD
FAU - Quarta, Giovanni
AU  - Quarta G
FAU - Cardona, Montserrat
AU  - Cardona M
FAU - Calcagnino, Margherita
AU  - Calcagnino M
FAU - Tsovolas, Konstantinos
AU  - Tsovolas K
FAU - Al-Shaikh, Shereen
AU  - Al-Shaikh S
FAU - Rahman, Shafiqur M
AU  - Rahman SM
FAU - Arnous, Samer
AU  - Arnous S
FAU - Jones, Sue
AU  - Jones S
FAU - McKenna, William
AU  - McKenna W
FAU - Elliott, Perry
AU  - Elliott P
LA  - eng
GR  - Department of Health/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20110713
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
SB  - IM
CIN - Heart. 2012 Jan;98(2):97-8. PMID: 21930726
MH  - Adult
MH  - Aged
MH  - Cardiomyopathy, Hypertrophic/*mortality/*therapy
MH  - *Defibrillators, Implantable
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Survival Analysis
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2011/07/16 06:00
MHDA- 2012/05/04 06:00
CRDT- 2011/07/16 06:00
PHST- 2011/07/16 06:00 [entrez]
PHST- 2011/07/16 06:00 [pubmed]
PHST- 2012/05/04 06:00 [medline]
AID - hrt.2010.217182 [pii]
AID - 10.1136/hrt.2010.217182 [doi]
PST - ppublish
SO  - Heart. 2012 Jan;98(2):116-25. doi: 10.1136/hrt.2010.217182. Epub 2011 Jul 13.