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Heart 1998;79:331-336 ( April )
a Cardiologia di S Luca, Ospedale di Careggi,
Florence, Italy, b Minneapolis
Heart Institute Foundation, Minneapolis, Minnesota, USA
Correspondence to: Dr F Cecchi, Via Jacopo Nardi, 30 Firenze, 50132, Italy.
Accepted for publication 29 September 1997
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.
AimsTo 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.
MethodsCardiovascular 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).
ResultsNine 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 (
2 runs)
and repetitive bursts (on 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.
ConclusionsIn 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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