Spectrum and prognostic significance of arrhythmias on ambulatory Holter electrocardiogram in hypertrophic cardiomyopathy
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Objectives The goal of this study was to assemble a profile and assess the significance of arrhythmias in a nontertiary-based hypertrophic cardiomyopathy (HCM) cohort.Background Hypertrophic cardiomyopathy is associated with arrhythmia-related consequences, particularly sudden death. Ventricular tachyarrhythmias on Holter electrocardiograms (ECG) have been reported as markers for sudden death in highly selected HCM populations.Methods We assessed the profile of ventricular and supraventricular ectopy and bradyarrhythmia on ambulatory 24-h Holter ECG and also related these findings to clinical outcome in 178 HCM patients.Results Of the 178 study patients, 157 (88%) had premature ventricular complexes (PVCs), including 21 (12%) with >/=500 PVCs, 74 (42%) had couplets, 67 (37%) had supraventricular tachycardia (SVT), and 56 (31%) had nonsustained ventricular tachycardia (NSVT). Mean number of PVCs was 330 +/- 763 (range 1 to 5,435) and increased with age (p < 0.01); NSVT was associated with greater left ventricular hypertrophy (p = 0.01) and severe symptoms (New York Heart Association functional classes III and IV) (p = 0.04); SVT occurred more commonly in patients with outflow obstruction (p = 0.02). Over a follow-up of 5.5 +/- 3.4 years, 11 (6%) patients died suddenly (annual mortality rate, 1.1%) including 5 patients with NSVT. For sudden death, NSVT on Holter ECG had negative and positive predictive values of 95% and 9%, and sensitivity and specificity of 45% and 69%, respectively.Conclusions In this nontertiary-based HCM cohort, ventricular and supraventricular tachyarrhythmias were particularly frequent and demonstrated a broad spectrum on ambulatory (Holter) ECG. Paradoxically, despite such a highly arrhythmogenic substrate, sudden death events proved to be relatively uncommon. Ventricular tachyarrhythmias had a low positive and relatively high negative predictive value for sudden death in this HCM population.
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Up to 30% of HCM patients present with NSVT episodes on Holter monitoring.
“Up to 30% of HCM patients present with NSVT episodes on Holter monitoring”
From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Adabag et al., 2005
NSVT in HCM is characterized by high negative predictive value (95%) but low positive predictive value.
“Nevertheless, NSVT is characterized by high negative (95%) but low positive predictive values”
From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Adabag et al., 2005
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- Authors
- Adabag, A. S., Casey, S. A., Kuskowski, M. A., Zenovich, A. G., & Maron, B. J.
- Affiliations
- Minneapolis Heart Institute Foundation (US)
- Minneapolis VA Medical Center (US)
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2005-03
- Volume
- 45
- Issue
- 5
- Pages
- 697-704
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2134380184
- Cited by
- 273
- References
- 38
- Citations by year
- 2026: 5 · 2025: 14 · 2024: 12 · 2023: 6 · 2022: 6 · 2021: 20 · 2020: 26 · 2019: 8 · 2018: 24 · 2017: 19 · 2016: 11 · 2015: 15 · 2014: 20 · 2013: 11 · 2012: 12
- FWCI
- 6.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Keywords
- hypertrophic cardiomyopathy, ventricular arrhythmias, premature ventricular contractions, non-sustained ventricular tachycardia, supraventricular tachycardia, sudden death, prognostic factors, Holter monitoring, left ventricular hypertrophy, outflow obstruction, bradycardia
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Bradycardia, Cardiomyopathy, Hypertrophic, Child, Child, Preschool, Female, Follow-Up Studies, Hospitals, Community, Humans, Male, Middle Aged, Minnesota, Risk Factors, Tachycardia, Supraventricular, Electrocardiography, Ambulatory, Comorbidity, Survival Analysis, Cardiology Service, Hospital, Death, Sudden, Cardiac, Tachycardia, Ventricular, Ventricular Premature Complexes, Atrial Premature Complexes
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