Effectiveness of subcutaneous implantable cardioverter-defibrillator testing in patients with hypertrophic cardiomyopathy

Niccoló Maurizi, Ilaria Tanini, Iacopo Olivotto, Ernesto Amendola, Giuseppe Limongelli, Maria Angela Losi, Giuseppe Allocca, Giovanni Battista Perego, Paolo Pieragnoli, Giuseppe Ricciardi, Paolo De Filippo, Paola Ferrari, Giovanni Quarta, Stefano Viani, Antonio Rapacciuolo, Maria Grazia Bongiorni, Franco Cecchi

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background Subcutaneous ICD (S-ICD) is a promising option for Hypertrophic Cardiomyopathy (HCM) patients at risk of Sudden Cardiac Death (SCD). However, its effectiveness in terminating ventricular arrhythmias in HCM is yet unresolved. Methods Consecutive HCM patients referred for S-ICD implantation were prospectively enrolled. Patients underwent one or two attempts of VF induction by the programmer. Successful conversion was defined as any 65 J shock that terminated VF (not requiring rescue shocks). Clinical and instrumental parameters were analyzed to study predictors of conversion failure. Results Fifty HCM patients (34 males, 40 ± 16 years) with a mean BMI of 25.2 ± 4.4 kg/m2 were evaluated. Mean ESC SCD risk of was 6.5 ± 3.9% and maximal LV wall thickness (LVMWT) was 26 ± 6 mm. In 2/50 patients no arrhythmias were inducible, while in 7 (14%) only sustained ventricular tachycardia was induced and cardioverted. In the remaining 41 (82%) patients, 73 VF episodes were induced (1 episode in 14 and > 1 in 27 patients). Of these, 4 (6%) spontaneously converted. In 68/69 (98%) the S-ICD successfully cardioverted, but failed in 1 (2%) patient, who needed rescue defibrillation. This patient was severely obese (BMI 36) and LVMWT of 25 mm. VF was re-induced and successfully converted by the 80 J reversed polarity S-ICD. Conclusions Acute DT at 65 J at the implant showed the effectiveness of S-ICD in the recognition and termination of VT/VF in all HCM patients except one. Extreme LVH did not affect the performance of the device, whereas severe obesity was likely responsible for the single 65 J failure.

Original languageEnglish
Pages (from-to)115-119
Number of pages5
JournalInternational Journal of Cardiology
Volume231
DOIs
Publication statusPublished - Mar 15 2017

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Implantable Defibrillators
Hypertrophic Cardiomyopathy
Sudden Cardiac Death
Cardiac Arrhythmias
Shock
Morbid Obesity
Ventricular Tachycardia
Equipment and Supplies

Keywords

  • Hypertrophic cardiomyopathy
  • S-ICD
  • Sudden death prevention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Effectiveness of subcutaneous implantable cardioverter-defibrillator testing in patients with hypertrophic cardiomyopathy. / Maurizi, Niccoló; Tanini, Ilaria; Olivotto, Iacopo; Amendola, Ernesto; Limongelli, Giuseppe; Losi, Maria Angela; Allocca, Giuseppe; Perego, Giovanni Battista; Pieragnoli, Paolo; Ricciardi, Giuseppe; De Filippo, Paolo; Ferrari, Paola; Quarta, Giovanni; Viani, Stefano; Rapacciuolo, Antonio; Bongiorni, Maria Grazia; Cecchi, Franco.

In: International Journal of Cardiology, Vol. 231, 15.03.2017, p. 115-119.

Research output: Contribution to journalArticle

Maurizi, N, Tanini, I, Olivotto, I, Amendola, E, Limongelli, G, Losi, MA, Allocca, G, Perego, GB, Pieragnoli, P, Ricciardi, G, De Filippo, P, Ferrari, P, Quarta, G, Viani, S, Rapacciuolo, A, Bongiorni, MG & Cecchi, F 2017, 'Effectiveness of subcutaneous implantable cardioverter-defibrillator testing in patients with hypertrophic cardiomyopathy', International Journal of Cardiology, vol. 231, pp. 115-119. https://doi.org/10.1016/j.ijcard.2016.12.187
Maurizi, Niccoló ; Tanini, Ilaria ; Olivotto, Iacopo ; Amendola, Ernesto ; Limongelli, Giuseppe ; Losi, Maria Angela ; Allocca, Giuseppe ; Perego, Giovanni Battista ; Pieragnoli, Paolo ; Ricciardi, Giuseppe ; De Filippo, Paolo ; Ferrari, Paola ; Quarta, Giovanni ; Viani, Stefano ; Rapacciuolo, Antonio ; Bongiorni, Maria Grazia ; Cecchi, Franco. / Effectiveness of subcutaneous implantable cardioverter-defibrillator testing in patients with hypertrophic cardiomyopathy. In: International Journal of Cardiology. 2017 ; Vol. 231. pp. 115-119.
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abstract = "Background Subcutaneous ICD (S-ICD) is a promising option for Hypertrophic Cardiomyopathy (HCM) patients at risk of Sudden Cardiac Death (SCD). However, its effectiveness in terminating ventricular arrhythmias in HCM is yet unresolved. Methods Consecutive HCM patients referred for S-ICD implantation were prospectively enrolled. Patients underwent one or two attempts of VF induction by the programmer. Successful conversion was defined as any 65 J shock that terminated VF (not requiring rescue shocks). Clinical and instrumental parameters were analyzed to study predictors of conversion failure. Results Fifty HCM patients (34 males, 40 ± 16 years) with a mean BMI of 25.2 ± 4.4 kg/m2 were evaluated. Mean ESC SCD risk of was 6.5 ± 3.9{\%} and maximal LV wall thickness (LVMWT) was 26 ± 6 mm. In 2/50 patients no arrhythmias were inducible, while in 7 (14{\%}) only sustained ventricular tachycardia was induced and cardioverted. In the remaining 41 (82{\%}) patients, 73 VF episodes were induced (1 episode in 14 and > 1 in 27 patients). Of these, 4 (6{\%}) spontaneously converted. In 68/69 (98{\%}) the S-ICD successfully cardioverted, but failed in 1 (2{\%}) patient, who needed rescue defibrillation. This patient was severely obese (BMI 36) and LVMWT of 25 mm. VF was re-induced and successfully converted by the 80 J reversed polarity S-ICD. Conclusions Acute DT at 65 J at the implant showed the effectiveness of S-ICD in the recognition and termination of VT/VF in all HCM patients except one. Extreme LVH did not affect the performance of the device, whereas severe obesity was likely responsible for the single 65 J failure.",
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AU - Maurizi, Niccoló

AU - Tanini, Ilaria

AU - Olivotto, Iacopo

AU - Amendola, Ernesto

AU - Limongelli, Giuseppe

AU - Losi, Maria Angela

AU - Allocca, Giuseppe

AU - Perego, Giovanni Battista

AU - Pieragnoli, Paolo

AU - Ricciardi, Giuseppe

AU - De Filippo, Paolo

AU - Ferrari, Paola

AU - Quarta, Giovanni

AU - Viani, Stefano

AU - Rapacciuolo, Antonio

AU - Bongiorni, Maria Grazia

AU - Cecchi, Franco

PY - 2017/3/15

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N2 - Background Subcutaneous ICD (S-ICD) is a promising option for Hypertrophic Cardiomyopathy (HCM) patients at risk of Sudden Cardiac Death (SCD). However, its effectiveness in terminating ventricular arrhythmias in HCM is yet unresolved. Methods Consecutive HCM patients referred for S-ICD implantation were prospectively enrolled. Patients underwent one or two attempts of VF induction by the programmer. Successful conversion was defined as any 65 J shock that terminated VF (not requiring rescue shocks). Clinical and instrumental parameters were analyzed to study predictors of conversion failure. Results Fifty HCM patients (34 males, 40 ± 16 years) with a mean BMI of 25.2 ± 4.4 kg/m2 were evaluated. Mean ESC SCD risk of was 6.5 ± 3.9% and maximal LV wall thickness (LVMWT) was 26 ± 6 mm. In 2/50 patients no arrhythmias were inducible, while in 7 (14%) only sustained ventricular tachycardia was induced and cardioverted. In the remaining 41 (82%) patients, 73 VF episodes were induced (1 episode in 14 and > 1 in 27 patients). Of these, 4 (6%) spontaneously converted. In 68/69 (98%) the S-ICD successfully cardioverted, but failed in 1 (2%) patient, who needed rescue defibrillation. This patient was severely obese (BMI 36) and LVMWT of 25 mm. VF was re-induced and successfully converted by the 80 J reversed polarity S-ICD. Conclusions Acute DT at 65 J at the implant showed the effectiveness of S-ICD in the recognition and termination of VT/VF in all HCM patients except one. Extreme LVH did not affect the performance of the device, whereas severe obesity was likely responsible for the single 65 J failure.

AB - Background Subcutaneous ICD (S-ICD) is a promising option for Hypertrophic Cardiomyopathy (HCM) patients at risk of Sudden Cardiac Death (SCD). However, its effectiveness in terminating ventricular arrhythmias in HCM is yet unresolved. Methods Consecutive HCM patients referred for S-ICD implantation were prospectively enrolled. Patients underwent one or two attempts of VF induction by the programmer. Successful conversion was defined as any 65 J shock that terminated VF (not requiring rescue shocks). Clinical and instrumental parameters were analyzed to study predictors of conversion failure. Results Fifty HCM patients (34 males, 40 ± 16 years) with a mean BMI of 25.2 ± 4.4 kg/m2 were evaluated. Mean ESC SCD risk of was 6.5 ± 3.9% and maximal LV wall thickness (LVMWT) was 26 ± 6 mm. In 2/50 patients no arrhythmias were inducible, while in 7 (14%) only sustained ventricular tachycardia was induced and cardioverted. In the remaining 41 (82%) patients, 73 VF episodes were induced (1 episode in 14 and > 1 in 27 patients). Of these, 4 (6%) spontaneously converted. In 68/69 (98%) the S-ICD successfully cardioverted, but failed in 1 (2%) patient, who needed rescue defibrillation. This patient was severely obese (BMI 36) and LVMWT of 25 mm. VF was re-induced and successfully converted by the 80 J reversed polarity S-ICD. Conclusions Acute DT at 65 J at the implant showed the effectiveness of S-ICD in the recognition and termination of VT/VF in all HCM patients except one. Extreme LVH did not affect the performance of the device, whereas severe obesity was likely responsible for the single 65 J failure.

KW - Hypertrophic cardiomyopathy

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