[SCD-FORUM] 103E RE: Prophylactic ICD in nonobstructive asymmetrical Idiopathic Hypertrophic Cardiomyopathy? Dr. Brembilla-Perrot

[SCD Symposium]

Dear Dr Dubner and Dr Schapachnick
I would like to answer to Dr Landeata.

AF is a frequent cause of syncope in HCM especially after 40 years.  
SD occurring in patients with HCM and AF is generally related to  
cardiac collapse and rarely due to VF. Therefore the indication of  
ICD is very debatable in a patient with history of familial SD, no VT  
on Holter monitoring, 50 years old and with presyncope proved as  
related to AF.
The main problem here is to avoid a rapid AF :
Amiodarone and beta blockers are the first choice drugs.
Sometimes the association of beta blockers with cibenzoline or  
disopyramide (shown several years ago to reduce LV obstruction) are  
useful.
More, in patients with refractory AF, curative treatment of atrial  
arrhythmia by RF catheter ablation is actually indicated.

Sincerely yours
B Brembilla-Perrot

B. BREMBILLA-PERROT, A. JACQUOT, D. BEURRIER, L. JACQUEMIN.  
Hypertrophic cardiomyopathy : value of atrial programmed electrical  
stimulation in patients with or without syncope with special  
reference to the role of atrial arrhythmias. Int J Cardiol 1997 ;  
59 : 47-56

--
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
>
> --
> Dr. Sergio Dubner
> President of Scientific Committee
>
> Dr. Edgardo Schapachnik
> President of Steering Committee
>
>
>
>
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