Serious arrhythmias in patients with apical hypertrophic cardiomyopathy

We report cases of serious arrhythmias associated with apical hypertrophic cardiomyopathy (AHCM), Thirty-one patients were referred to our institute t o undergo further assessment of their AHCM from 1988 to 1999, Three patient s with nonsustained ventricular tachycardia demonstrated an I-123-MIBG regi onal reduction in the tracer uptake. In two patients with ventricular fibri llation (VF), the findings from I-123-MIBG imaging revealed regional sympat hetic denervation in the inferior and lateral regions. Electrophysiologic s tudy demonstrated reproducible induction of VF in aborted sudden death and presyncopal patients, resulting in the need for an implantable defibriliato r device and amiodarone in each patient. Patients with refractory atrial fi brillation with a rapid ventricular response suffered from serious congesti ve heart failure. A prudent assessment and strategy in patients with this d isease would be indispensable in avoiding a disastrous outcome.