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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

View larger version (18K): [in a new window]   Figure 1 Flow diagram showing the clinical outcome of 178 patients with hypertrophic cardiomyopathy (HCM) who underwent 24-h ambulatory (Holter) electrocardiogram monitoring. HF = heart failure.

View larger version (13K): [in a new window]   Figure 2 Prevalence of ventricular and supraventricular arrhythmias on 24-h ambulatory (Holter) electrocardiogram recording in 178 patients with hypertrophic cardiomyopathy. NSVT = nonsustained ventricular tachycardia; PVC = premature ventricular complex; SVT = supraventricular tachycardia.

View larger version (15K): [in a new window]   Figure 3 Relation between age at 24-h ambulatory (Holter) electrocardiogram (ECG) monitoring and the number of premature ventricular complexes (PVCs) in the 157 hypertrophic cardiomyopathy patients with PVCs.

View larger version (23K): [in a new window]   Figure 4 Relation of symptom severity (top panel) and left ventricular outflow obstruction (bottom panel) with the occurrence of arrhythmias on 24-h ambulatory (Holter) electrocardiogram monitoring in 178 hypertrophic cardiomyopathy patients. AF = atrial fibrillation; LVOTG = left ventricular outflow tract gradient; NSVT = nonsustained ventricular tachycardia; NYHA = New York Heart Association; PVC = premature ventricular complex; SVT = supraventricular tachycardia.

View larger version (35K): [in a new window]   Figure 5 Relation between maximum left ventricular (LV) wall thickness and occurrence of various tachyarrhythmias on 24-h ambulatory (Holter) electrocardiogram recording in 178 hypertrophic cardiomyopathy patients. Nonsustained ventricular tachycardia (NSVT) increased progressively and in direct relation to maximal LV thickness (p = 0.02 by the chi-square test for trend). Supraventricular tachycardia (SVT) was less common in patients with maximal LV thickness 30 mm vs. <30 mm (p = 0.001). PVCs = premature ventricular complexes.