Imaging for electrophysiological procedures

Electrophysiology is one of the most rapidly growing area of cardiology. Currently >50,000 catheter ablations are performed in Europe every year and >200,000 patients receive a device for arrhythmia treatment, sudden death prevention, or cardiac resynchronization. The advantages and limitations of fluoroscopy are well known. The rapid development of implantable cardiac devices therapies and ablation procedures all depend on accurate and reliable imaging modalities for preprocedural assessments, intraprocedural guidance, detection of complications, and post-procedural assessment for the longitudinal follow-up of patients. Therefore, over the last decades, imaging become an integral part of electrophysiological procedures.

Abstract 14017: Contemporary Management Strategies Provide Low Mortality Rates for Young Patients with Hypertrophic Cardiomyopathy

Background: Historically, youthful age has been considered the time period of greatest risk for patients with hypertrophic cardiomyopathy (HCM), largely a consequence of increased risk of sudden cardiac death. However, the last two decades have witnessed emergence of an expanded risk stratification algorithm resulting in more reliable identification of at-risk patients and enhanced utilization of implantable cardioverter-defibrillators (ICD) for sudden death prevention. However, whether these advances have significantly altered mortality rates for young HCM patients is currently unresolved. Objective: Define the clinical course and adverse event rate in children and young adults with HCM. Methods: We studied the long-term outcomes of 321 consecutive HCM patients presenting at 2 institutions between 10 and 29 years of age, and followed over 7.2 ± 4.8 years. Results: Over follow-up, 302 patients (94%) survived to 27 ± 5 years, with the majority (96%) experiencing no or mild symptoms at last evaluation. HCM-related death occurred in 16 patients (5%; 0.7%/year): arrhythmic sudden death (n=12), complications following heart transplant (n=3), and progressive heart failure (n=1). In contrast, aborted HCM-related mortality occurred in 41 other high-risk HCM patients (implantable cardioverter-defibrillator (ICD) interventions for ventricular tachyarrhythmia [n =24], resuscitated out of hospital cardiac arrest [n=7], and heart transplant for advanced unrelenting heart failure [n=10]), 2.0%/year, and at a rate almost 3-fold higher than actual HCM mortality. Survival at 5- and 10-years (considering only HCM deaths) was excellent at 97% and 92%, and not significantly different from survival rates recently reported in HCM patients identified during mid-life (ages 30 to 59 years old; 98% and 94%, p=0.23). Conclusions: In a cohort of young HCM patients contemporary treatment strategies have resulted in low mortality (<1%/year), due largely to identification of high-risk patients who benefit from sudden death prevention with the ICD, creating the opportunity for extended longevity.