Preventing Sudden Death

Question 1

What features indicate high risk of sudden cardiac death?

Answer 1

Early age of symptom onset
Non-sustained ventricular tachycardia
Beta-Myosin Heavy Chain mutant cause
LVOTO with SAM

Question 2

What is the recommendation for sports participation?

Answer 2

HCM patients should avoid competitive sports as exercise-induced VT is shown to predict SCD - Class 1 level C evidence

Question 3

Who Should receive an ICD?

Answer 3

• Recommended for those who have sustained cardiac arrest caused by VF or VT, have sustained VT causing syncope and have a life expectancy of >1 year - Class 1 Level B evidence
• ICD is recommended for those with a >6% risk of SCD as determined by Risk SCD score and life expectancy >1 year - Class IIa level B
• ICD may be considered in those with 4-6% risk of SCD and life expectancy >1 year - Class IIa level B
• ICD may be considered in <4% risk of SCD ONLY if there are clinical features of prognostic importance - Class IIb level B
• ICD is NOT recommended for SCD risk <4% and no clinical features of importance - Class III level B