Prognostic value of non-sustained ventricular tachycardia and the potential role of amiodarone treatment in hypertrophic cardiomyopathy: assessment in an unselected non-referral based patient population
Open accessAbstract
BACKGROUND: Amiodarone has been reported to reduce the likelihood of sudden death in patients with hypertrophic cardiomyopathy (HCM). However, data regarding the clinical course in HCM have traditionally come from selected referral populations biased toward assessment of high risk patients. AIMS: To evaluate antiarrhythmic treatment for sudden death in an HCM population not subject to tertiary referral bias, closely resembling the true disease state present in the community. METHODS: Cardiovascular mortality was assessed in relation to the occurrence of non-sustained ventricular tachycardia (NSVT) on 24 or 48 hour ambulatory Holter recording, a finding previously regarded as a marker for sudden death, particularly when the arrhythmia was frequent, repetitive or prolonged. 167 consecutive patients were analysed by multiple Holter ECG recordings (mean (SD) 157 (129) hours) and followed for a mean of 10 (5) years. Only patients with multiple repetitive NSVT were treated with amiodarone, and in relatively low. doses (220 (44) mg/day). RESULTS: Nine HCM related deaths occurred: 8 were the consequence of congestive heart failure, but only 1 was sudden and unexpected. Three groups of patients were segregated based on their NSVT profile: group 1 (n = 39), multiple (> or = 2 runs) and repetitive bursts (on > or = 2 Holters) of NSVT, or prolonged runs of ventricular tachycardia, included 4 deaths due to heart failure; group 2 (n = 38), isolated infrequent bursts of NSVT, included 1 sudden death; group 3 (n = 90), without NSVT, included 4 heart failure deaths. Kaplan-Meier survival analysis showed no significant differences in survival between the three groups throughout follow up. CONCLUSIONS: In an unselected patient population with HCM, isolated, non-repetitive bursts of NSVT were not associated with adverse prognosis and so this arrhythmia does not appear to justify chronic antiarrhythmic treatment. Amiodarone, administered in relatively low doses, did not carry an independent and additive risk for cardiac mortality. Amiodarone may have contributed to the absence of sudden cardiac death in patients believed to be at higher risk because of multiple repetitive NSVT.
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Amiodarone seems a safe antiarrhythmic drug in AF patients with hypertrophic cardiomyopathy.
“Amiodarone seems a safe antiarrhythmic drug in AF patients with hypertrophic cardiomyopathy, 879”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [879]
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- Authors
- Cecchi, F., Olivotto, I., Montereggi, A., Squillatini, G., Dolara, A., & Maron, B. J.
- Affiliations
- Azienda Ospedaliero-Universitaria Careggi (IT)
- Corresponding author
- Cecchi, F
- Venue
- Heart
- Publisher
- BMJ
- Published
- 1998-04-01
- Volume
- 79
- Issue
- 4
- Pages
- 331-336
- ISSN
- 1355-6037 (ISSN-L)
- 1468-201X
- PMC
- PMC1728662
- OpenAlex
- W2140473519
- Cited by
- 134
- References
- 46
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 1 · 2023: 1 · 2022: 1 · 2020: 3 · 2019: 1 · 2018: 4 · 2017: 5 · 2016: 7 · 2015: 3 · 2014: 8 · 2013: 3 · 2012: 6
- FWCI
- 3.29
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Heart (publishedVersion)
- PubMed Central (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, non-sustained ventricular tachycardia, amiodarone, sudden cardiac death, antiarrhythmic therapy, prognosis, cardiovascular mortality, heart failure, Holter monitoring, unselected patient population, referral bias
- MeSH terms
- Adult, Aged, Amiodarone, Anti-Arrhythmia Agents, Cardiomyopathy, Hypertrophic, Echocardiography, Evaluation Studies as Topic, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prognosis, Electrocardiography, Ambulatory, Death, Sudden, Cardiac, Treatment Outcome, Tachycardia, Ventricular, Patient Selection
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