ARRHYTHMIAS IN HYPERTROPHIC CARDIOMYOPATHY

Supraventricular and ventricular arrhythmias, particularly nonsustaine d ventricular tachycardia, and ventricular premature beats are a commo n finding in patients with hypertrophic cardiomyopathy. Several invest igations have demonstrated that nonsustained ventricular tachycardia o n Holter monitoring is associated with an increased risk of sudden car diac death. It has been a long lasting controversial discussion whethe r suppression of these arrhythmias with drugs, such as amiodarone is c apable to reduce the incidence of sudden cardiac death, While recent s tudies have indicated that nonsustained ventricular tachycardia in asy mptomatic patients without additional risk factors, such as a positive family history of sudden cardiac death or syncope should not be treat ed prophylactically with amiodarone. Symptomatic patients with sustain ed ventricular tachycardias and/or syncope related to ventricular arrh ythmias should undergo ICD implantation. The implantation of an ICD in asymptomatic patients should be limited to those who have several ris k factors for sudden cardiac death. It is questionable whether other r isk stratifiers, such as programmed electrical stimulation may be help ful to identify asymptomatic patients who are at risk to die suddenly. Moreover, whether the demonstration of electrocardiogram fractionatio n during electrophysiological study is superior to the induction of su stained ventricular arrhythmias for risk stratification, needs further investigation.