Noninvasive risk stratification prevents sudden death due to paroxysmal atrial fibrillation in hypertrophic cardiomyopathy.
Sudden death is a tragic complication of hypertrophic cardiomyopathy. We report the case of a young patient with hypertrophic cardiomyopathy in whom an episode of atrial fibrillation triggered ventricular fibrillation and cardiac arrest. A 21-year-old man with nonobstructive hypertrophic cardiomyopathy underwent cardioverter-defibrillator implantation for primary prevention of sudden death, after risk stratification with noninvasive strategies. After 6 weeks, during a moderate effort, the patient had a syncopal episode, preceded by palpitations and dizziness, and terminated by the cardioverter-defibrillator. Device interrogation revealed an episode of atrial fibrillation with high ventricular response, spontaneously followed by ventricular tachycardia/fibrillation. Atrial fibrillation is a potential trigger of life-threatening arrhythmias and sudden death in patients with hypertrophic cardiomyopathy. Clinical investigation of risk markers for sudden death should be encouraged to identify high-risk patients who may benefit from a prophylactic therapy with an implantable cardioverter-defibrillator.
Limongelli
Giuseppe
G
Department of Cardiothoracic Sciences, Second University of Naples, Monaldi Hospital, Naples, Italy. limongelligiuseppe@libero.it
Elliott
Perry Mark
PM
Pacileo
Giuseppe
G
Sarubbi
Berardo
B
Thaman
Rajesh
R
Calabrò
Paolo
P
Vergara
Pasquale
P
Iacomino
Maria
M
Russo
Maria Giovanna
MG
Calabrò
Raffaele
R
D000328:Adult; D001281:Atrial Fibrillation / Q000150:complications* / Q000628:therapy; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications*; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D004554:Electric Countershock; D006801:Humans; D008297:Male; D018570:Risk Assessment