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Device Complications and Inappropriate Implantable Cardioverter Defibrillator Shocks in Patients with Hypertrophic Cardiomyopathy
  1. Grace Lin (lin.grace{at}mayo.edu)
  1. Mayo Clinic, United States
    1. Rick A Nishimura (rnishimura{at}mayo.edu)
    1. Mayo Clinic, United States
      1. Bernard J Gersh (gersh.bernard{at}mayo.edu)
      1. Mayo Clinic, United States
        1. Steve Ommen (ommen.steve{at}mayo.edu)
        1. Mayo Clinic, United States
          1. Michael Ackerman (ackerman.michael{at}mayo.edu)
          1. Mayo Clinic, United States
            1. Peter A Brady (brady.peter{at}mayo.edu)
            1. Mayo Clinic, United States

              Abstract

              Background: Although benefit of implantable cardioverter defibrillator (ICD) therapy in patients with hypertrophic cardiomyopathy (HCM) at risk for sudden cardiac arrest (SCA) is well established, there may be higher risk for device complications and inappropriate shocks.

              Objectives: To determine the incidence of inappropriate ICD shocks and device complications in HCM patients and the impact of young age at ICD implant and atrial fibrillation.

              Methods: HCM patients who underwent ICD implantation between January 1988 and December 2005 were included. Frequency of device complications, including pneumothorax, pericardial effusion, hematoma, lead revisions, infection, and rate of inappropriate shocks, was determined. ICD shocks were characterized as inappropriate if triggered by sinus tachycardia, atrial fibrillation, or device malfunction.

              Results: A total of 181 patients were included (mean age 44 ± 17 years; 62% males). During mean follow up of 59 ± 42 months (4.92 years; 830.75 patient-years), 65 patients (36%) had a total of 88 device complications, including 42 (23%) patients with inappropriate shocks. The rate of inappropriate shocks was 5.3% per year (vs. 4% risk of appropriate shocks) and likelihood of inappropriate ICD shocks per 100 patient-years was 5.1. Younger age and atrial fibrillation were associated with an increased risk of inappropriate ICD discharges.

              Conclusions: Rate of inappropriate ICD shocks and frequency of device complications in HCM patients is not insignificant and is most common in younger patients and those with atrial fibrillation. Inappropriate ICD shocks are the most common device complication and should be accounted for when counseling high risk HCM patients for ICD implantation.

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