Sudden cardiac arrest in patients with hypertrophic cardiomyopathy: Are there electrocardiographic predictors?

Abstract

Background

Hypertrophic cardiomyopathy (HCM) predisposes patients to cardiac arrest (CA). While established major risk factors may warrant the need for primary prevention by implantable cardioverter-defibrillator (ICD), it is unknown if specific electrocardiographic predictors are associated with CA. Our objective was to determine the risk of CA in patients with HCM based on the presence of identified electrocardiographic arrhythmias and conduction disorders.

Methods

We queried the National Inpatient Sample (NIS) from 4th quarter 2015 to 2020 to identify adult hospitalizations with HCM via ICD-10 codes excluding those presenting with syncope and those who had an ICD implant. We compared the odds of having CA in those with atrioventricular (AV) block, bundle branch block (BBB), atrial fibrillation (AF), atrial flutter (AFL), supraventricular tachycardia (SVT), and premature ventricular contractions (PVCs). Regression models were used to adjust for underlying medical comorbidities and patient demographics.

Results

Of 251,450 HCM hospitalizations, 12,573 (5 %) were associated with CA. Those who had CA were younger (63 vs 65 years, p < 0.001) and had fewer comorbidities based on their Charlson Comorbidity Index score (2.49 vs 2.83, p < 0.001) versus those without CA. The HCM cohort with first-, second- and third-degree AV block, left or right BBB, AF, AFL, SVT, or PVCs had increased odds of CA.

Conclusion

From the NIS database AV block, BBB, AF, AFL, SVT, and PVCs increased the odds of CA in HCM patients. Further prospective studies are warranted to determine if these predictors can pinpoint who may benefit from primary SCD prevention independent of other risk factors.