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Introduction Hypertrophic cardiomyopathy (HCM) is a leading cause of sudden cardiac death (SCD) in the young. The condition conferred a 0.32%/year incidence of SCD in contemporary epidemiological studies. Risk is highest in younger individuals and attenuates with advancing age. When contemplating ICD implantation for primary prevention of SCD, the accrued lifetime risk of ICD complication must be balanced against predicted SCD risk and patient preference. We examined the incidence of appropriate ICD therapies and device-related complication in HCM patients with primary prevention ICDs at our centre.Methods & Results This was a single-centre, retrospective study. We screened 1746 ICD implants from 2000–2025, identifying 99 HCM patients via Heart Rhythm Ireland and local electronic health record databases. 19 patients were excluded due to secondary prevention indication or follow-up at an external institution, leaving 80 patients for analysis. Mean follow-up time was 114months. 66% of patients were male with a mean age of 51years at implant. Devices were 75% single-chamber, 20% dual-chamber and 5% CRT-D. A majority (51%) were at intermediate risk of SCD (4–6%), while 27% were low risk (<4%) and 21% high risk (>6%). NSVT was the commonest risk marker (72%), followed by family history of SCD (36%), significant LVOT obstruction (16%), extreme LV hypertrophy (16%) and unexplained syncope (12%). 14 patients (18%) experienced appropriate therapy, despite 75% of this subset being beta blocked. All such patients were intermediate or high risk for SCD. 19 complications occurred, affecting 16 patients (20%). (see figure 1).Conclusions Potentially life-saving therapy was delivered in 18% of patients with HCM who underwent primary prevention ICD implantation. However, a comparable proportion experienced significant complications. Notably, all patients who received appropriate therapies were calculated at intermediate or high risk for SCD. These data will help to inform clinicians and patients when contemplating ICD therapy in this population.Abstract 82 Figure 1