cardiovascular disorders
Hypertrophic Cardiomyopathy Arrhythmias
Treatment of Hypertrophic Cardiomyopathy Arrhythmias
Moderation of physical activity For atrial fibrillation, antiarrhythmic drug therapy and anticoagulation for stroke prevention For ventricular arrhythmias, often an implantable cardioverter-defibrillator (ICD) Heart failure therapy (including transplantation) as required Outflow tract obstruction therapy as required (usually a beta-blocker but sometimes septal myomectomy or alcohol ablation) Patients with hypertrophic cardiomyopathy have typically been advised to avoid athletic exertion because such activities foster life-threatening arrhythmias and may hasten disease progression. However, current guidelines recommend that patients may continue to pursue recreational athletic activity after a comprehensive evaluation and shared discussion with an expert specialist in hypertrophic cardiomyopathy of potential risk (and the understanding that individual exercise risk cannot be precisely predicted— Treatment reference ). Foratrial tachyarrhythmias,standard treatment is used: rate-control with negative dromotropic drugs (usually a beta-blocker), rhythm control (usually withamiodarone), and thromboembolic risk reduction (usually withwarfarinor a direct acting oral anticoagulant). Forventricular arrhythmias,prevention of sudden death is with an ICD, which is recommended for patients with dilated cardiomyopathy and left ventricular ejection fraction of 35% or less and for patients with sustained ventricular tachycardia/ventricular fibrillation or resuscitated cardiac arrest. Because of the higher risk of sudden death in patients with hypertrophic cardiomyopathy, current guidelines also recommend an ICD for patients with other specific combinations of risk factors (see table). Antiarrhythmic drugs, usuallyamiodarone, are used to control frequently recurrent ventricular tachyarrhythmias leading to frequent ICD interventions, particularly ICD shocks. Standard measures for Treatment include beta-blockers and heart rate-limiting calcium channel blockers. On occasion, right ventricular pacing is used to treat outflow tract obstruction by purposefully inducing interventricular dyssynchrony. 1.Ommen SR, Mital S, Burke MA, et al: 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Circulation142(25):e533–e557, 2020. doi: 10.1161/CIR.0000000000000937 