Emergency Med Medical News about non-sustained ventricular tachycardia, sudden death, hypertrophic cardiomyopathy

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Exercise-induced ventricular arrhythmias and risk of sudden cardiac death in patients with hypertrophic cardiomyopathy
European Heart Journal, 08/21/09

Gimeno JR et al. – Ventricular arrhythmia during symptom limited exercise is rare in patients with hypertrophic cardiomyopathy, but is associated with an increased risk of sudden cardiac death.

Methods

Cohort study, with prospective data collection
Assessment of 1380 pts, referred to cardiomyopathy clinic in London, UK
Mean age 42 yrs (SD 15); 62% male; mean follow-up 54 (SD 49) mo
Evaluation by 2D and Doppler echocardiography, upright exercise testing, and Holter monitoring
Subjects: 27 pts; mean age 40 (SD 14) yrs (18–64); 22 (81.5%) male
Non-sustained ventricular tachycardia (NSVT) for 24 pts during exercise
Ventricular fibrillation (VF) for 3 pts during exercise

Results

During exercise, 13 pts (54.2%) had >1 run of NSVT (maximum 5) with a mean heart rate of 221 (SD 48) bpm
Pts with exercise NSVT/VF had more severe hypertrophy (22.6 vs 19.5 mm) and larger left atria (47.3 vs 43.7 mm)
Male gender significantly associated with exercise NSVT/VF [22 (81.5%) vs 832 (61.5%)
Mortality or cardiac event (SD/ICD discharge/transplant) for 8 (29.6%) of exercise NSVT/VF pts vs 150 (11.1%) pts without exercise NSVT/VF
NSVT/VF pts had a 3.73-fold increase in risk of SD/ICD discharge
Exercise NSVT alone associated with 2.82-fold increased risk
In multivariable analysis with other risk markers, exercise NSVT/VF (but not NSVT alone) independently associated with increased risk of SD/ICD

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