Evidence that pharmacological strategies lack efficacy for the prevention of sudden death in hypertrophic cardiomyopathy.
OBJECTIVE
To determine the efficacy of pharmacological treatment in the prevention of sudden cardiac death in hypertrophic cardiomyopathy (HCM).


METHODS
Clinical outcome was assessed retrospectively in 293 patients with HCM, including 173 who were taking cardioactive medications.


METHODS
Department of Cardiology, University of Padua, Padua, Italy; a tertiary HCM Centre.


METHODS
Medical treatment with beta blockers, verapamil, sotalol and amiodarone.


METHODS
HCM-related sudden cardiac death.


RESULTS
17 of 173 (10%) patients died suddenly or had aborted cardiac arrest, while being treated continuously with drugs having antiarrhythmic properties, over a period of 62 (56) months. Sudden death occurred in 20% of patients administered amiodarone (6/30), 9% each of patients taking verapamil (4/46) or beta blockers (7/76), and 0% of those taking sotalol (0/21). Patients taking cardioactive drugs (n = 173) and those without pharmaceutical therapy (n = 120) did not differ with respect to sudden death mortality.


CONCLUSIONS
Medical treatment is not absolutely protective against the risk of sudden death in HCM. The present data inferentially support the use of the implantable defibrillator as the primary treatment choice for prevention of sudden death in high-risk patients with HCM.
Melacini
P
P
Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy.
Maron
B J
BJ
Bobbo
F
F
Basso
C
C
Tokajuk
B
B
Zucchetto
M
M
Thiene
G
G
Iliceto
S
S
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D002312:Cardiomyopathy, Hypertrophic / Q000188:drug therapy* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013015:Sotalol / Q000627:therapeutic use; D014700:Verapamil / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D013015:Sotalol; D014700:Verapamil; D000638:Amiodarone