European Heart Journal Advance Access originally published online on August 17, 2009
European Heart Journal 2009 30(21):2599-2605; doi:10.1093/eurheartj/ehp327
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Exercise-induced ventricular arrhythmias and risk of sudden cardiac death in patients with hypertrophic cardiomyopathy
The Heart Hospital, University College London, 16–18 Westmoreland Street, London W1G 8PH, UK
Received 29 October 2008; revised 11 July 2009; accepted 23 July 2009; online publish-ahead-of-print 17 August 2009.
* Corresponding author. Tel: +44 207 573 8888, Fax: +44 207 573 8838, Email: pelliott{at}doctors.org.uk
See page 2558 for the editorial comment on this article (doi:10.1093/eurheartj/ehp307)
Background: Non-sustained ventricular tachycardia (NSVT) during ambulatory electrocardiographic monitoring (typically occurring at rest or during sleep) is associated with an increased risk of sudden cardiac death in patients with hypertrophic cardiomyopathy. The prevalence and prognostic significance of ventricular arrhythmias during exercise is unknown.
Methods and results: This was a cohort study, with prospective data collection. We studied 1380 patients, referred to a cardiomyopathy clinic in London, UK [mean age 42 years (SD 15); 62% male; mean follow-up 54 (SD 49) months]. Patients underwent two-dimensional and Doppler echocardiography, upright exercise testing, and Holter monitoring. Twenty-seven patients [mean age 40 (SD 14) years (18–64); 22 (81.5%) male] had NSVT (24) or ventricular fibrillation (VF) (3) during exercise. During exercise, 13 (54.2%) had more than one run of NSVT (maximum 5) with a mean heart rate of 221 (SD 48) b.p.m. Patients with exercise NSVT/VF had more severe hypertrophy (22.6 vs. 19.5 mm, P = 0.009) and larger left atria (47.3 vs. 43.7 mm, P = 0.03). Male gender was significantly associated with exercise NSVT/VF [22 (81.5%) vs. 832 (61.5%), P = 0.03]. Eight (29.6%) of the exercise NSVT/VF patients died or had a cardiac event (SD/ICD discharge/transplant) compared with 150 (11.1%) patients without exercise NSVT/VF, P = 0.008. Patients with NSVT/VF had a 3.73-fold increase in risk of SD/ICD discharge (HR 95% CI: 1.61–8.63, P = 0.002). Exercise NSVT alone was associated with a 2.82-fold increased risk (HR 95% CI: 1.02–7.75, P = 0.049). In multivariable analysis with other risk markers, exercise NSVT/VF (but not NSVT alone) was independently associated with an increased risk of SD/ICD [HR 3.14 (95% CI: 1.29–7.61, P = 0.01)].
Conclusion: Ventricular arrhythmia during symptom limited exercise is rare in patients with hypertrophic cardiomyopathy, but is associated with an increased risk of sudden cardiac death.
Key Words: Non-sustained ventricular tachycardia • Sudden death • Hypertrophic cardiomyopathy
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- Sudden cardiac death risk in hypertrophic cardiomyopathy
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EHJ 2009 30: 2558-2559.[Extract] [Full Text]
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  S. R. Ommen and B. J. Gersh Sudden cardiac death risk in hypertrophic cardiomyopathy Eur. Heart J., November 1, 2009; 30(21): 2558 - 2559. [Full Text] [PDF]
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