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Heart. Apr 1998; 79(4): 331–336.
PMCID: PMC1728662
Prognostic value of non-sustained ventricular tachycardia and the potential role of amiodarone treatment in hypertrophic cardiomyopathy: assessment in an unselected non-referral based patient population
F Cecchi, I Olivotto, A Montereggi, G Squillatini, A Dolara, and B Maron
Ospedale di Careggi, Florence, Italy.
Background—Amiodarone has been reported to reduce the likelihood of sudden death in patients with hypertrophic cardiomyopathy (HCM). However, data regarding the clinical course in HCM have traditionally come from selected referral populations biased toward assessment of high risk patients.
Aims—To evaluate antiarrhythmic treatment for sudden death in an HCM population not subject to tertiary referral bias, closely resembling the true disease state present in the community.
Methods—Cardiovascular mortality was assessed in relation to the occurrence of non-sustained ventricular tachycardia (NSVT) on 24 or 48 hour ambulatory Holter recording, a finding previously regarded as a marker for sudden death, particularly when the arrhythmia was frequent, repetitive or prolonged. 167 consecutive patients were analysed by multiple Holter ECG recordings (mean (SD) 157 (129) hours) and followed for a mean of 10 (5) years. Only patients with multiple repetitive NSVT were treated with amiodarone, and in relatively low doses (220 (44) mg/day).
Results—Nine HCM related deaths occurred: 8 were the consequence of congestive heart failure, but only 1 was sudden and unexpected. Three groups of patients were segregated based on their NSVT profile: group 1 (n = 39), multiple ([gt-or-equal, slanted] 2 runs) and repetitive bursts (on [gt-or-equal, slanted] 2 Holters) of NSVT, or prolonged runs of ventricular tachycardia, included 4 deaths due to heart failure; group 2 (n = 38), isolated infrequent bursts of NSVT, included 1 sudden death; group 3 (n = 90), without NSVT, included 4 heart failure deaths. Kaplan-Meier survival analysis showed no significant differences in survival between the three groups throughout follow up.
Conclusions—In an unselected patient population with HCM, isolated, non-repetitive bursts of NSVT were not associated with adverse prognosis and so this arrhythmia does not appear to justify chronic antiarrhythmic treatment. Amiodarone, administered in relatively low doses, did not carry an independent and additive risk for cardiac mortality. Amiodarone may have contributed to the absence of sudden cardiac death in patients believed to be at higher risk because of multiple repetitive NSVT.

Keywords: hypertrophic cardiomyopathy;  ventricular tachycardia;  amiodarone
Figure 1
Figure 1  
Flow diagram showing the three groups identified among the 202 HCM patients based on ambulatory Holter ECG findings. AF, atrial fibrillation; SVT supraventricular tachycardia; NSVT, non-sustained ventricular tachycardia.
Figure 2
Figure 2  
Kaplan-Meier estimates of cumulative survival during the period of follow up from the time of initial diagnosis of HCM in the three patient groups. There was no significant difference in survival between the three groups independent of whether a pooled (more ...)
Figure 3
Figure 3  
Kaplan-Meier estimates of cumulative survival during the period following the first detection of NSVT in 77 study patients. Survival did not differ significantly (p = 0.2) between patients with isolated infrequent NSVT receiving (more ...)
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