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.
Berritt Haynes, a 19 year old with hypertrophic cardiomyopathy, was chosen for Team Blake Shelton last night on the MGM Television/NBC show THE VOICE. After Berritt’s mother submitted a tape, Berritt was chosen to audition on stage in front of the coaches.
Berritt had hoped to attend a taping of the show last season through Make-A -Wish Foundation which grants wishes to kids with serious health issues. However, due to COVID, he was not able to make that happen. Instead, this year his mother helped make his dream come true by making it possible for him to actually perform.
Berritt was diagnosed with HCM when he was 8 and received an implantable defibrillator when he was 14. Clearly, Berritt’s HCM has not interfered with his performing talents. Watch him performing on The Voice here.
Good luck Berritt. All of the HCM world will be rooting for you to advance to the next round!
Read more at:
THE VOICE can be seen on NBC on Monday and Tuesday nights. Check your local schedule for times.
A recent study published in the European Journal of Preventative Cardiology found that a 12-lead electrocardiogram (EKG) was not useful as a screening tool to determine which children were at increased risk of sudden death and therefore, a candidate to receive an implantable defibrillator.
The full article can be found here.
In this study just published in the Heart Rhythm journal of the Heart Rhythm Society, doctors demonstrated that an Apple iPhone 12 (which is built with more magnets than previous iPhone models due to the Mag Safe charging technology) can disable the ability of an implantable defibrillator to deliver therapy.
So, this is a reminder for ICD patients that according to all device manufacturers, in order to avoid a problem, keep your phone at least 6 inches away from your device, and remember that you should NEVER PUT YOUR PHONE (ANY PHONE, NOT JUST AN IPHONE 12) IN YOUR SHIRT POCKET!
Here is an informative new video from our friend Doug Rachac that nicely explains the safety of MRIs for patients with implantable defibrillators and pacemakers.
I wrote a blog piece about this same issue a few years back. Here it is:
Yes We Scan! ICDs and MRIs
And a few other relevant blog entries here on HCMBeat:
Study Shows MRIs Safe for Pacemaker & ICD Patients
Chapter 3: MRI Safety for ICD & Pacemaker Patients
Safety of MRIs With Abandoned Leads
Last year, Doug wrote this blog entry for HCMBeat specifically about magnets and airports. Read that here:
Blogger Doug Rachac – Magnets and Airports: Should ICD Patients Be Afraid?
And, you can find more about ICDs from Doug on his YouTube Channel.
This informative blog article written by a social worker for the University of Michigan’s Health Blog has some great tips on how to deal with anxiety when living with an ICD.
I recommend it.
According to a paper published last week in JAMA Cardiology, doctors at Tufts University’s HCM Center have been able to identify 95% of their patients at high risk of sudden cardiac death (SCD) from HCM. Tufts applied an updated and modified version of the risk factors enumerated in the American College of Cardiology/American Heart Association Guidelines promulgated in 2011.
Continue reading “Docs Reliably Identify HCM Patients in Need of ICDs”
This story in the Wall Street Journal about genetic testing shows the speed of changes in the medical community’s understanding of how and whether certain genes cause hereditary disease.
The article quoted Dr. Jodie Ingles, a geneticist from the University of Sydney in Australia who specializes in HCM and has published a recent article on the subject. Dr. Ingles said that 22 out of 33 genes comprising a genetic testing panel commonly used to test for HCM had either limited or no evidence of being disease causative.
Continue reading “Wall Street Journal Highlights Risks in Genetic Testing”
Today, it was announced by the U.S. Department of Homeland Security that 750,000 implantable defibrillators manufactured by Medtronic could potentially be vulnerable to hacking.
Continue reading “Hackers and ICDs: What to Know About Today’s Medtronic Warning”
A recent study by doctors at the Cleveland Clinic suggests that the presence of late gadolinium enhancement (LGE) should be added to the various risk factors currently used to assess patients who are at low or intermediate risk of sudden death. The presence and balancing of these risk factors are used by patients and doctors to determine the need for implantable cardiac defibrillators (ICDs). LGE is an indication of cardiac scar tissue and can be seen on cardiac MRI scans. This study recommended that LGE comprising a total of 15% or more of left ventricular mass be used as an additional risk factor. The study found that this indicator worked equally well when applied to both obstructed and non-obstructive HCM patients.
Interestingly, an earlier but recent study published by Cleveland Clinic doctors found that the risk factors currently in use to determine the need for an ICD fall short as applied to patients with the obstructive form of HCM.
Risk factors in common use today have been propounded by the American College of CardiologyAmerican Heart Association (ACC/AHA) in the U.S., while a different set of guideline and a mathematical risk calculator was promulgated more recently in Europe by the European Society of Cardiology (ESC). You can find more about the ACC/AHA and ESC guidelines here.
A second and related finding of this study by the Cleveland Clinic, known for its large HCM program and high volume of myectomies, was that patients who undego myectomy appear to experience a protective effect from their surgeries. Even when found to have 25% or more LGE, patients in this study who previously underwent myectomy experienced a lower than expected rate of adverse events.