open access

Vol 63, No 8 (2005)
Other
Published online: 2005-08-19
Submitted: 2012-12-28
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CASE REPORT
Massive myocardial hypertrophy in hypertrophic cardiomyopathy: a risk factor for sudden death and high defibrillation threshold during cardioverter-defibrillator implantation

Marek Jastrzębski, Danuta Czarnecka, Bogumiła Bacior, Paweł Petkow-Dimitrow, Rajmund Wilczek, Kalina Kawecka-Jaszcz
Kardiol Pol 2005;63(8):191-195.

open access

Vol 63, No 8 (2005)
Other
Published online: 2005-08-19
Submitted: 2012-12-28

Abstract

Two cases of hypertrophic cardiomyopathy with massive hypertrophy and high defibrillation threshold (DFT) are described. A 14-year-old boy, whose single risk factor for sudden death was extreme hypertrophy with maximum interventricular septum (IVS) thickness of 43 mm, survived an episode of ventricular fibrillation. During ICD implantation DFT testing showed energy requirements >30 J and the procedure was aborted. Amiodarone and verapamil treatment was discontinued and treatment with oral sotalol was instituted. After a period of amiodarone washout the procedure was repeated and DFT of 24 J was encountered. An 18-year-old female with massive hypertrophy (IVS thickness=35 mm) and other risk factors for sudden death underwent ICD implantation for primary prevention. During the procedure DFT=20 J and ICD with 30 J maximal output was implanted. An increase in DFT to more than 20 J was encountered during pre-discharge test. Lack of 10 J safety margin warranted ICD system revision and upgrade; during the second procedure DFT was 24 J and ICD with 35 J maximal output was implanted. In summary, in both cases ICDs with 35 J maximal output were successfully implanted.

Abstract

Two cases of hypertrophic cardiomyopathy with massive hypertrophy and high defibrillation threshold (DFT) are described. A 14-year-old boy, whose single risk factor for sudden death was extreme hypertrophy with maximum interventricular septum (IVS) thickness of 43 mm, survived an episode of ventricular fibrillation. During ICD implantation DFT testing showed energy requirements >30 J and the procedure was aborted. Amiodarone and verapamil treatment was discontinued and treatment with oral sotalol was instituted. After a period of amiodarone washout the procedure was repeated and DFT of 24 J was encountered. An 18-year-old female with massive hypertrophy (IVS thickness=35 mm) and other risk factors for sudden death underwent ICD implantation for primary prevention. During the procedure DFT=20 J and ICD with 30 J maximal output was implanted. An increase in DFT to more than 20 J was encountered during pre-discharge test. Lack of 10 J safety margin warranted ICD system revision and upgrade; during the second procedure DFT was 24 J and ICD with 35 J maximal output was implanted. In summary, in both cases ICDs with 35 J maximal output were successfully implanted.
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Keywords

Hypertrophic cardiomyopathy; defibrillation threshold; sudden cardiac death

About this article
Title

CASE REPORT
Massive myocardial hypertrophy in hypertrophic cardiomyopathy: a risk factor for sudden death and high defibrillation threshold during cardioverter-defibrillator implantation

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 63, No 8 (2005)

Pages

191-195

Published online

2005-08-19

Bibliographic record

Kardiol Pol 2005;63(8):191-195.

Keywords

Hypertrophic cardiomyopathy
defibrillation threshold
sudden cardiac death

Authors

Marek Jastrzębski
Danuta Czarnecka
Bogumiła Bacior
Paweł Petkow-Dimitrow
Rajmund Wilczek
Kalina Kawecka-Jaszcz

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