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Circulation, Vol 80, 1259-1268, Copyright © 1989 by American Heart Association
L Fananapazir, CM Tracy, MB Leon, JB Winkler, RO Cannon 3d, RO Bonow, BJ Maron and SE Epstein
Electrophysiologic studies (EPS) were performed in 155 patients with
hypertrophic cardiomyopathy (HCM). Indications for EPS were cardiac arrest
in 22 patients, syncope in 55 patients, presyncope in 37 patients,
asymptomatic ventricular tachycardia (VT) in 24 patients, palpitations in
10 patients, and a strong family history of sudden cardiac death in seven
patients. Thirty-five (23%) patients had significant resting left
ventricular outflow tract obstruction. Electrophysiologic abnormalities
were present in 126 (81%) patients. A high prevalence of abnormal
sinus-node function (66%) and His-Purkinje (HV) conduction (30%) was noted.
The most commonly induced supraventricular arrhythmias were atrial
reentrant tachycardia and atrial fibrillation (10% and 11% of patients,
respectively). Accessory atrioventricular pathways were present in seven
(5%) patients. Programmed ventricular stimulation (PVS) induced
nonsustained ventricular tachycardia in 22 (14%) patients and sustained
ventricular arrhythmia in 66 (43%) patients. Sustained ventricular
arrhythmia was polymorphic VT in 48 (73%) patients, monomorphic VT in 16
(24%) patients, and ventricular fibrillation in two (3%) patients.
Induction was with two premature stimuli in 19 (29%) patients and three
premature stimuli in 47 (71%) patients. Of 17 cardiac arrest survivors with
sustained ventricular arrhythmia, 16 (94%) patients required three
premature stimuli for arrhythmia induction. Sustained ventricular
arrhythmia was induced at a right ventricular site in 51 (77%) patients and
at a left ventricular site in 15 (23%) patients. Univariate analysis showed
a significant (p less than 0.05) association between inducibility of
sustained ventricular arrhythmia and VT on Holter in patients with a
history of cardiac arrest or syncope but not in patients with presyncope or
asymptomatic patients. Multivariate logistic regression analysis revealed
that the following were significantly associated with inducibility of
sustained ventricular arrhythmia: clinical presentation (cardiac arrest
more than syncope more than presyncope more than asymptomatic patients, p =
0.0002; chronic or inducible atrial fibrillation, p = 0.002; and male
gender, p = 0.04). In contrast, there was no clinical correlate of induced
nonsustained VT.(ABSTRACT TRUNCATED AT 400 WORDS)
ARTICLES
Electrophysiologic abnormalities in patients with hypertrophic cardiomyopathy. A consecutive analysis in 155 patients
Cardiovascular Diagnostic Section, National Institutes of Health, Bethesda, Maryland 20892.
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