[SCD-FORUM] 91S RE: Prophylactic ICD in nonobstructive asymmetrical Idiopathic Hypertrophic Cardiomyopathy? Dr. Rondon

[SCD Symposium]

Cesar,

As you well asked, in risk stratification for patients with  
nonobstructive hypertrophic cardiomyopathy:

absence of familial sudden death
absence of evidence of malignant ventricular arrhythmia in Holter or  
EP lab
absence of late potentials in signal-averaged ECG
preserved LV function
absence of IV gradient
FC I

Rules out to a certain extent SCD risk in this population… now, what  
you have to try is for the patient to understand that he or she must  
have his/her treatment in a methodical way. A significant attempt is  
to find fractionated potentials and verify the possibility of  
pulmonary veins isolation, by ablation with Ensite system, to  
decrease even more the risk of rapid events of AF …

Regards,

Mauricio Rondón

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee


>
> Dear attendants to this great symposium on the Internet,
> I wish to pose the case of a 50-year-old female patient with first  
> episode (3 years ago) of paroxysmal atrial fibrillation with rapid  
> ventricular response (170 b/min), which was accompanied by  
> precordial oppression and prolonged presyncope. She has been  
> receiving treatment with verapamil, atenolol, separately or  
> combined, inconstantly. In a recurrent way, she presents clinics of  
> “palpitations” related to paroxysmal AF in several ECG recordings,  
> now with preserved ventricular response. The resting ECG shows a  
> sinus rhythm pattern, and a normal one. TT echocardiogram shows  
> baseline Septum Hypertrophy of 15 mm (asymmetrical) without  
> Intraventricular or transvalvular gradients; the left atrium  
> slightly dilated, the LVEF is preserved. The functional class is I  
> according to the NYHA. She denies family history of “sudden” death  
> due to any cause. I am thinking of starting treatment with  
> amiodarone to prevent recurrences of AF. However, what role may the  
> indication of an ICD have to prevent SCD on this patient? Which  
> would be the other risk stratification tests for SD applicable in  
> this situation?
>
> Thank you very much,
> Dr. César Landaeta T.
> Cardiologo Electrofisiólogo
> Venezuela
>
>

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