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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
- 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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