CLINICAL RESEARCH: LVH AND ARRHYTHMIAS
Spectrum and prognostic significance of arrhythmias on ambulatory Holter electrocardiogram in hypertrophic cardiomyopathy
A. Selcuk Adabag, MD*,*,
Susan A. Casey, RN ,
Michael A. Kuskowski, PhD*,
Andrey G. Zenovich, MSc and
Barry J. Maron, MD, FACC
* Division of Cardiology, and Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Minneapolis, Minnesota
Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
Manuscript received June 27, 2004;
revised manuscript received November 12, 2004,
accepted November 16, 2004.
* Reprint requests and correspondence: Dr. A. Selcuk Adabag, Veterans Affairs Medical Center, Section of Cardiology (111 C), 1 Veterans Drive, Minneapolis, Minnesota 55417 (Email: adaba001{at}umn.edu).
OBJECTIVES: The goal of this study was to assemble a profile and assess the significance of arrhythmias in a nontertiary-based hypertrophic cardiomyopathy (HCM) cohort.
BACKGROUND: Hypertrophic cardiomyopathy is associated with arrhythmia-related consequences, particularly sudden death. Ventricular tachyarrhythmias on Holter electrocardiograms (ECG) have been reported as markers for sudden death in highly selected HCM populations.
METHODS: We assessed the profile of ventricular and supraventricular ectopy and bradyarrhythmia on ambulatory 24-h Holter ECG and also related these findings to clinical outcome in 178 HCM patients.
RESULTS: Of the 178 study patients, 157 (88%) had premature ventricular complexes (PVCs), including 21 (12%) with  500 PVCs, 74 (42%) had couplets, 67 (37%) had supraventricular tachycardia (SVT), and 56 (31%) had nonsustained ventricular tachycardia (NSVT). Mean number of PVCs was 330 ± 763 (range 1 to 5,435) and increased with age (p < 0.01); NSVT was associated with greater left ventricular hypertrophy (p = 0.01) and severe symptoms (New York Heart Association functional classes III and IV) (p = 0.04); SVT occurred more commonly in patients with outflow obstruction (p = 0.02). Over a follow-up of 5.5 ± 3.4 years, 11 (6%) patients died suddenly (annual mortality rate, 1.1%) including 5 patients with NSVT. For sudden death, NSVT on Holter ECG had negative and positive predictive values of 95% and 9%, and sensitivity and specificity of 45% and 69%, respectively.
CONCLUSIONS: In this nontertiary-based HCM cohort, ventricular and supraventricular tachyarrhythmias were particularly frequent and demonstrated a broad spectrum on ambulatory (Holter) ECG. Paradoxically, despite such a highly arrhythmogenic substrate, sudden death events proved to be relatively uncommon. Ventricular tachyarrhythmias had a low positive and relatively high negative predictive value for sudden death in this HCM population.
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Abbreviations and Acronyms
| | AV = atrioventricular | | HCM = hypertrophic cardiomyopathy | | LV = left ventricle/ventricular | | NSVT = nonsustained ventricular tachycardia | | NYHA = New York Heart Association | | PVC = premature ventricular complex | | SVT = supraventricular tachycardia |
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