CLINICAL RESEARCH
Non-sustained ventricular tachycardia in hypertrophic cardiomyopathy
an independent marker of sudden death risk in young patients
Lorenzo Monserrat, MD ,
Perry M. Elliott, MD, MRCP, FACC*,*,
Juan R. Gimeno, MD*,
Sanjay Sharma, BSc, MRCP*,
Manuel Penas-Lado, MD and
William J. McKenna, MD, FACC, FESC, FRCP*
* Department of Cardiological Sciences, St. George's Hospital Medical School, London, United Kingdom
Service of Cardiology, Juan Canalejo Hospital, A Coruña, Spain
Manuscript received September 13, 2002;
revised manuscript received January 15, 2003,
accepted February 10, 2003.
* Reprint requests and correspondence: Dr. Perry M. Elliott, Department of Cardiological Sciences, St. George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, United Kingdom.
pelliott{at}sghms.ac.uk
OBJECTIVES: The aim of this study was to examine the characteristics of non-sustained ventricular tachycardia (NSVT) episodes during Holter monitoring and to determine their relationship to age and prognosis.
BACKGROUND: It has been suggested that NSVT is only of prognostic importance in patients with hypertrophic cardiomyopathy (HCM) when repetitive, prolonged, or associated with symptoms.
METHODS: We studied 531 patients with HCM (323 male, 39 ± 15 years). All underwent ambulatory electrocardiogram monitoring (41 ± 11 h).
RESULTS: A total of 104 patients (19.6%) had NSVT. The proportion of patients with NSVT increased with age (p = 0.008). Maximum left ventricular wall thickness and left atrial size were greater in patients with NSVT. Mean follow-up was 70 ± 40 months. Sixty-eight patients died, 32 from sudden cardiac death (SCD). Twenty-one patients received an implantable cardioverter defibrillator (ICD). There were four appropriate ICD discharges. In patients  30 years (but not >30), five-year freedom from sudden death was lower in those with NSVT (77.6% [95% confidence interval (CI): 59.8 to 95.4] vs. 94.1% [95% CI: 90.2 to 98.0]; p = 0.003). There was no relation between the duration, frequency, or rate of NSVT runs and prognosis at any age. The odds ratio of sudden death in patients 30 years of age with NSVT was 4.35 (95% CI: 1.54 to 12.28; p = 0.006) compared with 2.16 (95% CI: 0.82 to 5.69; p = 0.1) in patients >30 years of age.
CONCLUSIONS: Non-sustained ventricular tachycardia is associated with a substantial increase in sudden death risk in young patients with HCM. A relation between the frequency, duration, and rate of NSVT episodes could not be demonstrated.
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Abbreviations and Acronyms
| | CI | | confidence interval | | HCM | | hypertrophic cardiomyopathy | | ICD | | implantable cardioverter defibrillator | | LV | | left ventricular | | NSVT | | non-sustained ventricular tachycardia | | SCD | | sudden cardiac death |
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