Arrhythmia Monitoring in HCM

Arrhythmia monitoring in HCM patients is used not only for determining risk of sudden death and potential need for an implantable defibrillator, but also for detecting atrial fibrillation (AFib) and implementing anti-coagulation for stroke prevention.

A recent paper provides an overview of the usefulness of arrhythmia monitoring in patients with HCM. 

THERE ARE DIFFERENT TYPES OF EVENT MONITORS

There are several varieties of event monitor available: some are used for a day or two, some for a couple of weeks, and some implantable devices such as implantable loop recorders can be used to record rhythm abnormalities for several years.

WHEN IS MONITORING APPROPRIATE?

The 2020 AHA/ACC Guidelines recommend arrhythmia monitoring at initial evaluation and then every 1 or 2 years thereafter. Extended monitoring is also recommended for patients with palpitations or lightheaded episodes in order to ascertain and treat the cause.

MONITORING FOR ATRIAL FIBRILLATION

This paper highlights the fact that patients with HCM who have Afib risk factors should undergo an initial screening for AFib and then repeat arrhythmia monitoring every 1 to 2 years thereafter.

IMPORTANT NOTE -The prevalence of AFib in HCM is 4 to 6 times higher than in the general population. Documented AFib of more than 24 hours duration requires lifelong treatment with anti-coagulants in order to avoid a thromboembolic stroke.

MONITORING FOR NON-SUSTAINED VENTRICULAR TACHYCARDIA (NSVT)

Episodes of NSVT found during monitoring, especially when looked at in conjunction with other risk factors, may support the recommendation of an implantable defibrillator.

HCM Treatment: The View from OHSU

If you are looking for a good survey of current practices in the treatment of HCM, a recent article published in the journal Structural Heart by Dr. Ahmad Masri and the team at Oregon Health and Sciences University (OHSU) provides an informative overview of thirty controversies and considerations in the treatment of HCM. This article explains in some detail how the doctors at this HCM Center approach these situations. 

Continue reading “HCM Treatment: The View from OHSU”

New Treatment for Arrhythmias

As reported in this New York Times article, radiation has been used as a successful treatment in five patients with ventricular arrhythmias who had previously failed standard treatment using catheter radiofrequency ablation.  The complete study was published last week in the New England Journal of Medicine.

Because long term effects of radiation to the heart are unknown, this method is still quite experimental and could potentially cause long term side effects such as lung and heart damage.  Science Daily reported that the researchers have performed the procedure on 23 patients to date, and are currently enrolling patients in a clinical trial.