Implantable cardioverter-defibrillator therapy in hypertrophic cardiomyopathy: A SIMPLE substudy

作者：Vamos Mate; Healey Jeff S; Wang Jia; Connolly Stuart J; Mabo Philippe; Van Erven Lieselot; Kautzner Josef; Glikson Michael; Neuzner Jorg; O'Hara Gilles; Vinolas Xavier; Gadler Frederik; Hohnloser Stefan H^*

来源：Heart Rhythm, 2018, 15(3): 386-392.

DOI：10.1016/j.hrthm.2017.11.020

• Defibrillation testing
• Hypertrophic cardiomyopathy
• Implantable cardioverter-defibrillator

BACKGROUND Patients with hypertrophic cardiomyopathy (HCM) are considered to be at high risk for elevated defibrillation thresholds, periprocedural complications, and failed appropriate shocks.
OBJECTIVE The purpose of this study was to determine the value of defibrillation testing (DT) in HCM patients undergoing implantable cardioverter-defibrillator (ICD) insertion.
METHODS Defibrillation thresholds, perioperative complications, and long-term outcomes were compared between patients with HCM and those with ischemic cardiomyopathy (ICM) or dilated cardiomyopathy (DCM) enrolled in the SIMPLE (Shockless IMPLant Evaluation) trial (Clinialtrials.gov Identifier: NCT00800384). In patients with HCM, outcomes were also compared between those randomized to DT vs no DT.
RESULTS Adequate defibrillation safety margin without system change was achieved in 46 of 52 (88.5%) HCM and 948 of 1047 (90.5%) ICM/DCM patients (P = .63). Perioperative complications occurred in 1 of 52 (1.9%) HCM patients with DT compared to 67 of 1047 (6.4%) ICM/DCM patients with DT (P = .37) or 3 of 42 (7.1%) HCM patients without DT (P = .32). During follow-up, there was no significant difference between HCM vs ICM/DCM patients in terms of all-cause mortality (adjusted hazard ratio [HR] 1.02, 95% confidence interval [CI] 0.45-2.34), composite of arrhythmic death or failed appropriate shock (adjusted HR 0.33, 95% CI 0.04-2.42), inappropriate shocks (adjusted HR 1.64, 95% CI 0.69-3.89), or system complications (adjusted HR 1.93, 95% CI 0.88-4.27). All-cause mortality (HR 0.26, 95% CI 0.03-2.20), appropriate (HR 0.24, 95% CI 0.03-2.05), and inappropriate shocks (HR 2.13, 95% CI 0.51-8.94) were similar in HCM patients without or those with DT.
CONCLUSION We did not find any difference in intraoperative defibrillation efficacy, perioperative complications, and long-term outcomes between patients with HCM and those with ICM/DCM. DT did not improve intraoperative or clinical shock efficacy in HCM patients.

• 出版日期2018-3