Primary prevention of sudden death in patients with hypertrophic cardiomyopathy follow specific criteria. In those patients with symptomatic LVOT obstruction, the indication of septal myectomy may prolong survival. However, it is advisable to implant an AICD postoperatively in patients with a greater risk of ventricular arrhythmias, despite no residual LVOT obstruction is present. The question is whether the degree of myocardial fibrosis or other risk factors is associated with a persistent risk of sudden death in surgically treated hypertrophic cardiomyopathy. Moreover, surgical myectomy minimize the likelihood of arrhythmia-related sudden death?
Beta blocker could be the drug of choice for such patients with arrhythmia-related sudden death.
Releasing LVOT obstruction diminishes symptoms, specifically exercise related syncope, but not necessarily arrhythmia related sudden death that is related to the intrinsic myocardial disease.
Dear Fernando,
Concerning last question. It is essentially to determine whether of primary or secondary prevention of SCD in HCM we should discuss on the basis of estimation of SCD risk. If it concerns patients with HCM who survive VF or sustained ventricular tachycardia are at very high risk of subsequent lethal cardiac arrhythmias and should receive an ICD, then identification of individuals without a history of VF, who are at high risk of SCD, remains a challenge and only a small subgroup of individuals currently treated with an ICD receives potentially lifesaving shocks [PM Elliott, 2014 ESC Guidelines on diagnosis and Mx of HCM]. Both LVOT and maximum left ventricular wall thicknessa are among variables for recommended assessment HCM Risk-SCD. But does surgical myectomy minimize the likelihood of arrhythmia-related SCD is not clear. I think decision about ICD in HCM who underwent alcohol septal ablation or septal myectomia must be made on an individual basis with inclusion in consideration of known factors.
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