EP Fellows Curriculum: Hypertrophic Cardiomyopathy - Diagnosis and Treatment 2020-EP Fellows Curriculum: Hypertrophic Cardiomyopathy

Video Transcription

Video Summary

In this video summary, Dr. Barry Maron discusses hypertrophic cardiomyopathy (HCM), the most common cardiovascular genetic disease. HCM is the most common cause of sudden death in young individuals and athletes, but it can affect individuals of any age. It is often unrecognized and can lead to heart failure, atrial fibrillation (AFib), and stroke. Diagnosis is typically made based on unexplained ALB hypertrophy and ruling out other differential diagnoses. Treatment options for heart failure symptoms include medications, transplants, surgical myectomies, and alcohol septal ablation. The choice between surgical myectomy and alcohol septal ablation depends on individual anatomy and the availability of experienced surgeons. AFib is common in individuals with HCM and is associated with a worse outcome. Anticoagulation is essential for HCM patients with AFib due to the higher risk of stroke. Risk stratification for sudden cardiac death in HCM is complex and based on several factors including family history, alveolar thickness, recent unexplained syncope, and non-sustained ventricular tachycardia (VT). ICDs are generally recommended for individuals with HCM at high risk of sudden death, but risk stratification is challenging due to the limited ability to predict which patients will die suddenly. The choice between transvenous and subcutaneous ICDs depends on individual characteristics and preferences. Pacing for LVOT obstruction is primarily considered in individuals over 60 with symptoms, obstruction, and heart failure. Atrial fibrillation in HCM is influenced by genetic mutations and atrial myopathy. Ablation strategies for AFib in HCM are similar to those used in other populations and include pulmonary vein isolation and additional lesion sets depending on individual characteristics.

Keywords

hypertrophic cardiomyopathy

sudden death

heart failure

atrial fibrillation

stroke

diagnosis

treatment options

ICDs