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Rella V, Maurizi N, Bernardini A, Brasca FM, Salerno S, Meda M, Mariani D, Torchio M, Ravaro S, Cerea P, Castelletti S, Fumagalli C, Conte G, Auricchio A, Girolami F, Pieragnoli P, Carrassa GM, Parati G, Olivotto I, Perego GB, Cecchi F, Crotti L. Candidacy and long-term outcomes of subcutaneous implantable cardioverter-defibrillators in current practice in patients with hypertrophic cardiomyopathy. Int J Cardiol 2024; 409:132202. [PMID: 38795975 DOI: 10.1016/j.ijcard.2024.132202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/16/2024] [Accepted: 05/22/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND In patients with Hypertrophic Cardiomyopathy (HCM) S-ICD is usually the preferred option as pacing is generally not indicated. However, limited data are available on its current practice adoption and long-term follow-up. METHODS Consecutive HCM patients with S-ICD implanted between 2013 and 2021 in 3 international centers were enrolled in this observational study. Baseline, procedural and follow-up data were regularly collected. Efficacy and safety were compared with a cohort of HCM patients implanted with a tv-ICD. RESULTS Seventy patients (64% males) were implanted with S-ICD at 41 ± 15 years, whereas 168 patients with tv-ICD at 49 ± 16 years. For S-ICD patients, mean ESC SCD risk score was 4,5 ± 1.9%: 25 (40%) at low-risk, 17 (27%) at intermediate and 20 (33%) at high-risk. Patients were followed-up for 5.1 ± 2.3 years. Two patients (0.6 per 100-person-years, vs 0.4 per 100 person-years with tv-ICD, p = 0.45) received an appropriate shock on VF, 17 (24%) were diagnosed with de-novo AF. Inappropriate shocks occurred in 4 patients (1.2 per 100-person-years, vs 0.9 per 100 person-years with tv-ICD, p = 0.74), all before Smart-Pass algorithm implementation. Four patients experienced device-related adverse events (1.2 per 100-person-years, vs 1 per 100 person-years with tv-ICD, p = 0.35%). CONCLUSIONS S-ICDs were often implanted in patients with an overall low-intermediate ESC SCD risk, reflecting both the inclusion of additional risk markers and a lower decision threshold. S-ICDs in HCM patients followed for over 5 years showed to be effective in conversion of VF and safe. Greater scrutiny may be required to avoid overtreatment in patients with milder risk profiles.
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Affiliation(s)
- V Rella
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - N Maurizi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - A Bernardini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Santa Maria Nuova Hospital, Cardiology and Electrophysiology unit, Florence, Italy
| | - F M Brasca
- Istituto Auxologico Italiano IRCCS, Electrophysiology Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - S Salerno
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - M Meda
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - D Mariani
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - M Torchio
- Istituto Auxologico Italiano IRCCS, Laboratory of Cardiovascular Genetics, Milan, Italy
| | - S Ravaro
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy; Department of medicine and surgery, University Milano Bicocca, Milan, Italy
| | - P Cerea
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - S Castelletti
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - C Fumagalli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - G Conte
- Istituto Cardiocentro Ticino, Department of Cardiology, Lugano, Switzerland
| | - A Auricchio
- Istituto Cardiocentro Ticino, Department of Cardiology, Lugano, Switzerland
| | - F Girolami
- Pediatric Cardiology Unit, Meyer Children's Hospital IRCCS, 50139 Florence, Italy
| | - P Pieragnoli
- Electrophysiology unit, Department of Cardiology, Careggi University Hospital, Florence, Italy
| | - G M Carrassa
- Electrophysiology unit, Department of Cardiology, Careggi University Hospital, Florence, Italy
| | - G Parati
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy; Department of medicine and surgery, University Milano Bicocca, Milan, Italy
| | - I Olivotto
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Pediatric Cardiology Unit, Meyer Children's Hospital IRCCS, 50139 Florence, Italy
| | - G B Perego
- Istituto Auxologico Italiano IRCCS, Electrophysiology Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - F Cecchi
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - L Crotti
- Department of medicine and surgery, University Milano Bicocca, Milan, Italy; Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Center for Cardiac Arrhythmias of Genetic Origin, Laboratory of Cardiovascular Genetics, Milan, Italy.
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Losi MA, Monda E, Lombardi R, Lioncino M, Canciello G, Rubino M, Todde G, Caiazza M, Borrelli F, Fusco A, Cirillo A, Perillo EF, Sepe J, Pacella D, de Simone G, Calabro P, Esposito G, Limongelli G. Prediction of incident atrial fibrillation in hypertrophic cardiomyopathy. Int J Cardiol 2024; 395:131575. [PMID: 37951419 DOI: 10.1016/j.ijcard.2023.131575] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 09/18/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND AND AIM Atrial fibrillation (AF) is the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM) with significant effects on outcome. We aim to compare the left atrial (LA) diameter measurement with HCM-AF Score in predicting atrial fibrillation (AF) development in HCM. METHODS From the regional cohort of the Campania Region, Italy, 519 HCM patients (38% women, age45 ± 17 years) without history of AF, were enrolled in the study. The primary clinical endpoint was the development of AF, defined as at least 1 episode documented by ECG. RESULTS During the follow-up (mean 8 ± 6, IQ range 2.5-11.2 years), 99 patients (19%) developed AF. Patients who developed AF were more symptomatic, had higher prevalence of ICD implantation, had larger LA diameter, greater left ventricular (LV) maximal wall thickness and LV outflow tract obstruction (p < 0.01). Both LA diameter and HCM-AF score were higher in patients who developed AF versus those who did not (LA diameter 49 ± 7 versus 43 ± 6 mm; HCM-AF score 22 ± 4 versus 19 ± 4; p < 0.0001); however, ROC curve analysis demonstrated that LA diameter had a significant greater area under the curve than HCM-AF Score (p < 0.0001). At 5 years follow-up, a LA diameter > 46 mm, showed a similar accuracy in predicting AF development of HCM-AF score ≥ 22, which identifies patients at high risk to develop AF. CONCLUSION Our analysis shows that LA diameter, a worldwide and simple echocardiographic measure, is capable alone to predict AF development in HCM patients.
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Affiliation(s)
- Maria Angela Losi
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
| | - Emanuele Monda
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Raffaella Lombardi
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Michele Lioncino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Grazia Canciello
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Marta Rubino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Gaetano Todde
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Felice Borrelli
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Adelaide Fusco
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Annapaola Cirillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | | | - Joseph Sepe
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Daniela Pacella
- Department of Public Health, University Federico II, Naples, Italy
| | - Giovanni de Simone
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Paolo Calabro
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
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Limongelli G, Monda E. Implantable cardioverter defibrillator in hypertrophic cardiomyopathy: Time to avoid unnecessary procedure. Int J Cardiol 2022; 355:30-31. [PMID: 35217097 DOI: 10.1016/j.ijcard.2022.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy; Institute of Cardiovascular Sciences, University College of London and St. Bartholomew's Hospital, London, UK.
| | - Emanuele Monda
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
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