Hypertrophic cardiomyopathy automatic implantable cardiac defibrillator placement: Difference between revisions

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(/* Selection of Patients for ICDs (DO NOT EDIT){{cite journal| author=Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS et al.| title=2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: a...)
 
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{{Hypertrophic cardiomyopathy}}
{{Hypertrophic cardiomyopathy}}


'''Editor-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org]; {{AOEIC}} [[Cafer Zorkun, M.D.]] [mailto:zorkun@perfuse.org]; Caitlin J. Harrigan [mailto:charrigan@perfuse.org]; Martin S. Maron, M.D.; Barry J. Maron, M.D.; {{LG}}
'''Editor-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com]; {{AOEIC}} [[Cafer Zorkun, M.D.]] [mailto:zorkun@perfuse.org]; Caitlin J. Harrigan [mailto:charrigan@perfuse.org]; Martin S. Maron, M.D.; Barry J. Maron, M.D.; {{LG}}


==Automatic Implantable Cardiac Defibrillator (AICD) placement==
==Automatic Implantable Cardiac Defibrillator (AICD) placement==
The role of AICD (automatic implantable cardiac defibrillator) placement in HCM is controversial. It offers the best potential benefit for survival and should probably be implanted in survivors of SCD and those deemed at high risk by clinical parameters. Nonetheless, the impact on prognosis is unclear because tachyarrhythmias may not always be the mechanism for syncope and sudden death. In addition, older patients may be self-selected “survivors” that stand to gain less from ICD placement. One recent retrospective study showed that at an average follow-up of 128 patients at 3.1 years, 23 percent had shocks for VT (ventricular tachycardia) and 25% had inappropriate shocks. Of those receiving the ICD prophylactically, 5% were shocked per year. This study did not evaluate the role of clinical predictors, evaluate total mortality and was a non-randomized retrospective design that does not establish the need for ICD placement in all patients with HCM or superiority to amiodarone therapy.
The role of AICD (automatic implantable cardiac defibrillator) placement in HCM is controversial. It offers the best potential benefit for survival and should probably be implanted in survivors of SCD and those deemed at high risk by clinical parameters. Nonetheless, the impact on prognosis is unclear because tachyarrhythmias may not always be the mechanism for syncope and sudden death. In addition, older patients may be self-selected “survivors” that stand to gain less from ICD placement. One recent retrospective study showed that at an average follow-up of 128 patients at 3.1 years, 23 percent had shocks for VT (ventricular tachycardia) and 25% had inappropriate shocks. Of those receiving the ICD prophylactically, 5% were shocked per year. This study did not evaluate the role of clinical predictors, evaluate total mortality and was a non-randomized retrospective design that does not establish the need for ICD placement in all patients with HCM or superiority to amiodarone therapy.


==2011 ACCF/AHA Guideline Recommendations: Selection of Patients for ICDs (DO NOT EDIT)==
==2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy (DO NOT EDIT)<ref name="pmid22068435">{{cite journal| author=Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS et al.| title=2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= 124 | issue= 24 | pages= 2761-96 | pmid=22068435 | doi=10.1161/CIR.0b013e318223e230 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22068435  }} </ref>==
{{cquote|


===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]===
===Selection of Patients for ICDs (DO NOT EDIT)<ref name="pmid22068435">{{cite journal| author=Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS et al.| title=2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= 124 | issue= 24 | pages= 2761-96 | pmid=22068435 | doi=10.1161/CIR.0b013e318223e230 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22068435  }} </ref>===


'''1.'''     The decision to place an ICD in patients with HCM should include application of individual clinical judgment, as well as a thorough discussion of the strength of evidence, benefits, and risks to allow the informed patient's active participation in decision making.   Normal  0          false  false  false    EN-US  X-NONE  X-NONE                                                                                                                                                                                                                                                                                                                                                            ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' The decision to place an [[ICD]] in patients with [[HCM]] should include application of individual clinical judgment, as well as a thorough discussion of the strength of evidence, benefits, and risks to allow the informed patient's active participation in decision making<ref name="pmid20100987">{{cite journal |author=Maron BJ |title=Contemporary insights and strategies for risk stratification and prevention of sudden death in hypertrophic cardiomyopathy |journal=Circulation |volume=121 |issue=3 |pages=445–56 |year=2010 |month=January |pmid=20100987 |doi=10.1161/CIRCULATIONAHA.109.878579 |url=}}</ref><ref name="pmid17652294">{{cite journal |author=Maron BJ, Spirito P, Shen WK, ''et al.'' |title=Implantable cardioverter-defibrillators and prevention of sudden cardiac death in hypertrophic cardiomyopathy |journal=JAMA |volume=298 |issue=4 |pages=405–12 |year=2007 |month=July |pmid=17652294 |doi=10.1001/jama.298.4.405 |url=}}</ref><ref name="pmid10666426">{{cite journal |author=Maron BJ, Shen WK, Link MS, ''et al.'' |title=Efficacy of implantable cardioverter-defibrillators for the prevention of sudden death in patients with hypertrophic cardiomyopathy |journal=N. Engl. J. Med. |volume=342 |issue=6 |pages=365–73 |year=2000 |month=February |pmid=10666426 |doi=10.1056/NEJM200002103420601 |url=}}</ref><ref name="pmid18384577">{{cite journal |author=Maron BJ, Spirito P |title=Implantable defibrillators and prevention of sudden death in hypertrophic cardiomyopathy |journal=J. Cardiovasc. Electrophysiol. |volume=19 |issue=10 |pages=1118–26 |year=2008 |month=October |pmid=18384577 |doi=10.1111/j.1540-8167.2008.01147.x |url=}}</ref>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' ICD placement is recommended for patients with HCM with prior documented [[cardiac arrest]], [[ventricular fibrillation]], or hemodynamically significant [[VT]]<ref name="pmid2703610">{{cite journal |author=Cecchi F, Maron BJ, Epstein SE |title=Long-term outcome of patients with hypertrophic cardiomyopathy successfully resuscitated after cardiac arrest |journal=J. Am. Coll. Cardiol. |volume=13 |issue=6 |pages=1283–8 |year=1989 |month=May |pmid=2703610 |doi= |url=}}</ref><ref name="pmid10334430">{{cite journal |author=Elliott PM, Sharma S, Varnava A, Poloniecki J, Rowland E, McKenna WJ |title=Survival after cardiac arrest or sustained ventricular tachycardia in patients with hypertrophic cardiomyopathy |journal=J. Am. Coll. Cardiol. |volume=33 |issue=6 |pages=1596–601 |year=1999 |month=May |pmid=10334430 |doi= |url=}}</ref><ref name="pmid1516184">{{cite journal |author=Fananapazir L, Chang AC, Epstein SE, McAreavey D |title=Prognostic determinants in hypertrophic cardiomyopathy. Prospective evaluation of a therapeutic strategy based on clinical, Holter, hemodynamic, and electrophysiological findings |journal=Circulation |volume=86 |issue=3 |pages=730–40 |year=1992 |month=September |pmid=1516184 |doi= |url=}}</ref><ref name="pmid17652294">{{cite journal |author=Maron BJ, Spirito P, Shen WK, ''et al.'' |title=Implantable cardioverter-defibrillators and prevention of sudden cardiac death in hypertrophic cardiomyopathy |journal=JAMA |volume=298 |issue=4 |pages=405–12 |year=2007 |month=July |pmid=17652294 |doi=10.1001/jama.298.4.405 |url=}}</ref>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|}


===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)===
{|class="wikitable"
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' It is reasonable to recommend an ICD for patients with HCM with:<br>'''a.'''  Sudden death presumably caused by HCM in 1 or more first-degree relatives<ref name="pmid21059440">{{cite journal |author=Bos JM, Maron BJ, Ackerman MJ, ''et al.'' |title=Role of family history of sudden death in risk stratification and prevention of sudden death with implantable defibrillators in hypertrophic cardiomyopathy |journal=Am. J. Cardiol. |volume=106 |issue=10 |pages=1481–6 |year=2010 |month=November |pmid=21059440 |doi=10.1016/j.amjcard.2010.06.077 |url=}}</ref>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <br>
'''b.''' A maximum LV wall thickness greater than or equal to 30 mm<ref name="pmid11127463">{{cite journal |author=Elliott PM, Poloniecki J, Dickie S, ''et al.'' |title=Sudden death in hypertrophic cardiomyopathy: identification of high risk patients |journal=J. Am. Coll. Cardiol. |volume=36 |issue=7 |pages=2212–8 |year=2000 |month=December |pmid=11127463 |doi= |url=}}</ref><ref name="pmid11273061">{{cite journal |author=Elliott PM, Gimeno Blanes JR, Mahon NG, Poloniecki JD, McKenna WJ |title=Relation between severity of left-ventricular hypertrophy and prognosis in patients with hypertrophic cardiomyopathy |journal=Lancet |volume=357 |issue=9254 |pages=420–4 |year=2001 |month=February |pmid=11273061 |doi=10.1016/S0140-6736(00)04005-8 |url=}}</ref><ref name="pmid16762758">{{cite journal |author=Sorajja P, Nishimura RA, Ommen SR, Ackerman MJ, Tajik AJ, Gersh BJ |title=Use of echocardiography in patients with hypertrophic cardiomyopathy: clinical implications of massive hypertrophy |journal=J Am Soc Echocardiogr |volume=19 |issue=6 |pages=788–95 |year=2006 |month=June |pmid=16762758 |doi=10.1016/j.echo.2006.01.005 |url=}}</ref><ref name="pmid10853000">{{cite journal |author=Spirito P, Bellone P, Harris KM, Bernabo P, Bruzzi P, Maron BJ |title=Magnitude of left ventricular hypertrophy and risk of sudden death in hypertrophic cardiomyopathy |journal=N. Engl. J. Med. |volume=342 |issue=24 |pages=1778–85 |year=2000 |month=June |pmid=10853000 |doi=10.1056/NEJM200006153422403 |url=}}</ref>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<br>
'''c.''' One or more recent, unexplained syncopal episodes<ref name="pmid19307481">{{cite journal |author=Spirito P, Autore C, Rapezzi C, ''et al.'' |title=Syncope and risk of sudden death in hypertrophic cardiomyopathy |journal=Circulation |volume=119 |issue=13 |pages=1703–10 |year=2009 |month=April |pmid=19307481 |doi=10.1161/CIRCULATIONAHA.108.798314 |url=}}</ref>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>''</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' An ICD can be useful in select patients with [[NSVT]] (particularly those <30 years of age) in the presence of other SCD risk factors or modifiers<ref name="pmid12957435">{{cite journal |author=Monserrat L, Elliott PM, Gimeno JR, Sharma S, Penas-Lado M, McKenna WJ |title=Non-sustained ventricular tachycardia in hypertrophic cardiomyopathy: an independent marker of sudden death risk in young patients |journal=J. Am. Coll. Cardiol. |volume=42 |issue=5 |pages=873–9 |year=2003 |month=September |pmid=12957435 |doi= |url=}}</ref><ref name="pmid20100987">{{cite journal |author=Maron BJ |title=Contemporary insights and strategies for risk stratification and prevention of sudden death in hypertrophic cardiomyopathy |journal=Circulation |volume=121 |issue=3 |pages=445–56 |year=2010 |month=January |pmid=20100987 |doi=10.1161/CIRCULATIONAHA.109.878579 |url=}}</ref>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' An ICD can be useful in select patients with HCM with an abnormal blood pressure response with exercise in the presence of other SCD risk factors or modifiers<ref name="pmid10362212">{{cite journal |author=Olivotto I, Maron BJ, Montereggi A, Mazzuoli F, Dolara A, Cecchi F |title=Prognostic value of systemic blood pressure response during exercise in a community-based patient population with hypertrophic cardiomyopathy |journal=J. Am. Coll. Cardiol. |volume=33 |issue=7 |pages=2044–51 |year=1999 |month=June |pmid=10362212 |doi= |url=}}</ref><ref name="pmid9386166">{{cite journal |author=Sadoul N, Prasad K, Elliott PM, Bannerjee S, Frenneaux MP, McKenna WJ |title=Prospective prognostic assessment of blood pressure response during exercise in patients with hypertrophic cardiomyopathy |journal=Circulation |volume=96 |issue=9 |pages=2987–91 |year=1997 |month=November |pmid=9386166 |doi= |url=}}</ref><ref name="pmid9761089">{{cite journal |author=Maki S, Ikeda H, Muro A, ''et al.'' |title=Predictors of sudden cardiac death in hypertrophic cardiomyopathy |journal=Am. J. Cardiol. |volume=82 |issue=6 |pages=774–8 |year=1998 |month=September |pmid=9761089 |doi= |url=}}</ref>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' It is reasonable to recommend an ICD for high-risk children with HCM, based on unexplained syncope, massive [[LV hypertrophy]], or family history of [[SCD]], after taking into account the relatively high complication rate of long-term ICD implantation. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>


===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]===
|}
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]===


}}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The usefulness of an ICD is uncertain in patients with HCM with isolated bursts of NSVT when in the absence of any other SCD risk factors or modifiers<ref name="pmid20100987">{{cite journal |author=Maron BJ |title=Contemporary insights and strategies for risk stratification and prevention of sudden death in hypertrophic cardiomyopathy |journal=Circulation |volume=121 |issue=3 |pages=445–56 |year=2010 |month=January |pmid=20100987 |doi=10.1161/CIRCULATIONAHA.109.878579 |url=}}</ref>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' The usefulness of an ICD is uncertain in patients with HCM with an abnormal blood pressure response with exercise when in the absence of any other SCD risk factors or modifiers, particularly in the presence of significant outflow obstruction<ref name="pmid10362212">{{cite journal |author=Olivotto I, Maron BJ, Montereggi A, Mazzuoli F, Dolara A, Cecchi F |title=Prognostic value of systemic blood pressure response during exercise in a community-based patient population with hypertrophic cardiomyopathy |journal=J. Am. Coll. Cardiol. |volume=33 |issue=7 |pages=2044–51 |year=1999 |month=June |pmid=10362212 |doi= |url=}}</ref><ref name="pmid9386166">{{cite journal |author=Sadoul N, Prasad K, Elliott PM, Bannerjee S, Frenneaux MP, McKenna WJ |title=Prospective prognostic assessment of blood pressure response during exercise in patients with hypertrophic cardiomyopathy |journal=Circulation |volume=96 |issue=9 |pages=2987–91 |year=1997 |month=November |pmid=9386166 |doi= |url=}}</ref><ref name="pmid9761089">{{cite journal |author=Maki S, Ikeda H, Muro A, ''et al.'' |title=Predictors of sudden cardiac death in hypertrophic cardiomyopathy |journal=Am. J. Cardiol. |volume=82 |issue=6 |pages=774–8 |year=1998 |month=September |pmid=9761089 |doi= |url=}}</ref>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}


==Guideline Resources==
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
 
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' [[ICD]] placement as a routine strategy in patients with HCM without an indication of increased risk is potentially harmful. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
 
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' ICD placement as a strategy to permit patients with HCM to participate in competitive athletics is potentially harmful. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
 
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''3.''' ICD placement in patients who have an identified HCM genotype in the absence of clinical manifestations of HCM is potentially harmful. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
 
|}
 
===Selection of ICD Device Type (DO NOT EDIT)<ref name="pmid22068435">{{cite journal| author=Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS et al.| title=2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= 124 | issue= 24 | pages= 2761-96 | pmid=22068435 | doi=10.1161/CIR.0b013e318223e230 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22068435  }} </ref>===
 
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' In patients with HCM who meet indications for ICD implantation, single-chamber devices are reasonable in younger patients without a need for atrial or ventricular [[pacing]]<ref name="pmid15477422">{{cite journal |author=Boriani G, Maron BJ, Shen WK, Spirito P |title=Prevention of sudden death in hypertrophic cardiomyopathy: but which defibrillator for which patient? |journal=Circulation |volume=110 |issue=15 |pages=e438–42 |year=2004 |month=October |pmid=15477422 |doi=10.1161/01.CIR.0000144463.65977.C9 |url=}}</ref><ref name="pmid18984525">{{cite journal |author=Hauser RG, Maron BJ, Marine JE, ''et al.'' |title=Safety and efficacy of transvenous high-voltage implantable cardioverter-defibrillator leads in high-risk hypertrophic cardiomyopathy patients |journal=Heart Rhythm |volume=5 |issue=11 |pages=1517–22 |year=2008 |month=November |pmid=18984525 |doi=10.1016/j.hrthm.2008.08.021 |url=}}</ref><ref name="pmid17470696">{{cite journal |author=Kleemann T, Becker T, Doenges K, ''et al.'' |title=Annual rate of transvenous defibrillation lead defects in implantable cardioverter-defibrillators over a period of >10 years |journal=Circulation |volume=115 |issue=19 |pages=2474–80 |year=2007 |month=May |pmid=17470696 |doi=10.1161/CIRCULATIONAHA.106.663807 |url=}}</ref><ref name="pmid11497532">{{cite journal |author=Maisel WH, Sweeney MO, Stevenson WG, Ellison KE, Epstein LM |title=Recalls and safety alerts involving pacemakers and implantable cardioverter-defibrillator generators |journal=JAMA |volume=286 |issue=7 |pages=793–9 |year=2001 |month=August |pmid=11497532 |doi= |url=}}</ref>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' In patients with HCM who meet indications for ICD implantation, dual-chamber ICDs are reasonable for patients with [[sinus bradycardia]] and/or paroxysmal [[AF]]<ref name="pmid15477422">{{cite journal |author=Boriani G, Maron BJ, Shen WK, Spirito P |title=Prevention of sudden death in hypertrophic cardiomyopathy: but which defibrillator for which patient? |journal=Circulation |volume=110 |issue=15 |pages=e438–42 |year=2004 |month=October |pmid=15477422 |doi=10.1161/01.CIR.0000144463.65977.C9 |url=}}</ref>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' In patients with HCM who meet indications for ICD implantation, dual-chamber ICDs are reasonable for patients with elevated resting outflow gradients greater than 50 mm Hg and significant heart failure symptoms who may benefit from right ventricular pacing (most commonly, but not limited to, patients >65 years of age)<ref name="pmid10359738">{{cite journal |author=Maron BJ, Nishimura RA, McKenna WJ, Rakowski H, Josephson ME, Kieval RS |title=Assessment of permanent dual-chamber pacing as a treatment for drug-refractory symptomatic patients with obstructive hypertrophic cardiomyopathy. A randomized, double-blind, crossover study (M-PATHY) |journal=Circulation |volume=99 |issue=22 |pages=2927–33 |year=1999 |month=June |pmid=10359738 |doi= |url=}}</ref><ref name="pmid9015001">{{cite journal |author=Nishimura RA, Trusty JM, Hayes DL, ''et al.'' |title=Dual-chamber pacing for hypertrophic cardiomyopathy: a randomized, double-blind, crossover trial |journal=J. Am. Coll. Cardiol. |volume=29 |issue=2 |pages=435–41 |year=1997 |month=February |pmid=9015001 |doi= |url=}}</ref><ref name="pmid9458416">{{cite journal |author=Kappenberger L, Linde C, Daubert C, ''et al.'' |title=Pacing in hypertrophic obstructive cardiomyopathy. A randomized crossover study. PIC Study Group |journal=Eur. Heart J. |volume=18 |issue=8 |pages=1249–56 |year=1997 |month=August |pmid=9458416 |doi= |url=}}</ref><ref name="pmid15477422">{{cite journal |author=Boriani G, Maron BJ, Shen WK, Spirito P |title=Prevention of sudden death in hypertrophic cardiomyopathy: but which defibrillator for which patient? |journal=Circulation |volume=110 |issue=15 |pages=e438–42 |year=2004 |month=October |pmid=15477422 |doi=10.1161/01.CIR.0000144463.65977.C9 |url=}}</ref>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|}
 
==ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death - Hypertrophic Cardiomyopathy (DO NOT EDIT)<ref name="pmid16935995">{{cite journal| author=Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M et al.| title=ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=Circulation | year= 2006 | volume= 114 | issue= 10 | pages= e385-484 | pmid=16935995 | doi=10.1161/CIRCULATIONAHA.106.178233 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16935995}}</ref>==
 
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[ICD]] therapy should be used for treatment in patients with hypertrophic cardiomyopathy (HCM) who have sustained VT and/or VF and who are receiving chronic optimal medical therapy and who have reasonable expectation of survival with a good functional status for more than 1 y. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|}
 
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' [[ICD implantation]] can be effective for primary [[prophylaxis]] against [[Sudden cardiac death|SCD]] in patients with HCM who have one or more major risk factor for SCD and who are receiving chronic optimal medical therapy and in patients who have reasonable expectation of survival with a good functional status for more than 1 y. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' [[Amiodarone]] therapy can be effective for treatment in patients with HCM with a history of sustained VT and/or VF when [[ICD]] is not feasible. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
 
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' [[EP testing]] may be considered for risk assessment for [[Sudden cardiac death|SCD]] in patients with HCM. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' [[Amiodarone]] may be considered for primary [[prophylaxis]] against [[Sudden cardiac death|SCD]] in patients with HCM who have one or more major risk factor for SCD, if [[ICD]] implantation is not feasible. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}
 
==Sources==
*[http://circ.ahajournals.org/content/117/21/e350.full.pdf ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities] <ref name="Epstein"> Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM III, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices). Circulation. 2008; 117: 2820–2840. PMID 18483207 </ref>
*[http://circ.ahajournals.org/content/117/21/e350.full.pdf ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities] <ref name="Epstein"> Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM III, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices). Circulation. 2008; 117: 2820–2840. PMID 18483207 </ref>


Latest revision as of 20:34, 28 October 2016

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Hypertrophic cardiomyopathy automatic implantable cardiac defibrillator placement On the Web

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D. [2]; Caitlin J. Harrigan [3]; Martin S. Maron, M.D.; Barry J. Maron, M.D.; Lakshmi Gopalakrishnan, M.B.B.S. [4]

Automatic Implantable Cardiac Defibrillator (AICD) placement

The role of AICD (automatic implantable cardiac defibrillator) placement in HCM is controversial. It offers the best potential benefit for survival and should probably be implanted in survivors of SCD and those deemed at high risk by clinical parameters. Nonetheless, the impact on prognosis is unclear because tachyarrhythmias may not always be the mechanism for syncope and sudden death. In addition, older patients may be self-selected “survivors” that stand to gain less from ICD placement. One recent retrospective study showed that at an average follow-up of 128 patients at 3.1 years, 23 percent had shocks for VT (ventricular tachycardia) and 25% had inappropriate shocks. Of those receiving the ICD prophylactically, 5% were shocked per year. This study did not evaluate the role of clinical predictors, evaluate total mortality and was a non-randomized retrospective design that does not establish the need for ICD placement in all patients with HCM or superiority to amiodarone therapy.

2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy (DO NOT EDIT)[1]

Selection of Patients for ICDs (DO NOT EDIT)[1]

Class I
"1. The decision to place an ICD in patients with HCM should include application of individual clinical judgment, as well as a thorough discussion of the strength of evidence, benefits, and risks to allow the informed patient's active participation in decision making[2][3][4][5]. (Level of Evidence: C) "
"2. ICD placement is recommended for patients with HCM with prior documented cardiac arrest, ventricular fibrillation, or hemodynamically significant VT[6][7][8][3]. (Level of Evidence: B) "
Class IIa
"1. It is reasonable to recommend an ICD for patients with HCM with:
a. Sudden death presumably caused by HCM in 1 or more first-degree relatives[9]. (Level of Evidence: C)

b. A maximum LV wall thickness greater than or equal to 30 mm[10][11][12][13]. (Level of Evidence: C)
c. One or more recent, unexplained syncopal episodes[14]. (Level of Evidence: C) ''

"2. An ICD can be useful in select patients with NSVT (particularly those <30 years of age) in the presence of other SCD risk factors or modifiers[15][2]. (Level of Evidence: C) "
"3. An ICD can be useful in select patients with HCM with an abnormal blood pressure response with exercise in the presence of other SCD risk factors or modifiers[16][17][18]. (Level of Evidence: C) "
"4. It is reasonable to recommend an ICD for high-risk children with HCM, based on unexplained syncope, massive LV hypertrophy, or family history of SCD, after taking into account the relatively high complication rate of long-term ICD implantation. (Level of Evidence: C) "
Class IIb
"1. The usefulness of an ICD is uncertain in patients with HCM with isolated bursts of NSVT when in the absence of any other SCD risk factors or modifiers[2]. (Level of Evidence: C) "
"2. The usefulness of an ICD is uncertain in patients with HCM with an abnormal blood pressure response with exercise when in the absence of any other SCD risk factors or modifiers, particularly in the presence of significant outflow obstruction[16][17][18]. (Level of Evidence: C) "
Class III (Harm)
"1. ICD placement as a routine strategy in patients with HCM without an indication of increased risk is potentially harmful. (Level of Evidence: C)"
"2. ICD placement as a strategy to permit patients with HCM to participate in competitive athletics is potentially harmful. (Level of Evidence: C)"
"3. ICD placement in patients who have an identified HCM genotype in the absence of clinical manifestations of HCM is potentially harmful. (Level of Evidence: C)"

Selection of ICD Device Type (DO NOT EDIT)[1]

Class IIa
"1. In patients with HCM who meet indications for ICD implantation, single-chamber devices are reasonable in younger patients without a need for atrial or ventricular pacing[19][20][21][22]. (Level of Evidence: B)"
"2. In patients with HCM who meet indications for ICD implantation, dual-chamber ICDs are reasonable for patients with sinus bradycardia and/or paroxysmal AF[19]. (Level of Evidence: C)"
"3. In patients with HCM who meet indications for ICD implantation, dual-chamber ICDs are reasonable for patients with elevated resting outflow gradients greater than 50 mm Hg and significant heart failure symptoms who may benefit from right ventricular pacing (most commonly, but not limited to, patients >65 years of age)[23][24][25][19]. (Level of Evidence: B) "

ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death - Hypertrophic Cardiomyopathy (DO NOT EDIT)[26]

Class I
"1. ICD therapy should be used for treatment in patients with hypertrophic cardiomyopathy (HCM) who have sustained VT and/or VF and who are receiving chronic optimal medical therapy and who have reasonable expectation of survival with a good functional status for more than 1 y. (Level of Evidence: B) "
Class IIa
"1. ICD implantation can be effective for primary prophylaxis against SCD in patients with HCM who have one or more major risk factor for SCD and who are receiving chronic optimal medical therapy and in patients who have reasonable expectation of survival with a good functional status for more than 1 y. (Level of Evidence: C)"
"2. Amiodarone therapy can be effective for treatment in patients with HCM with a history of sustained VT and/or VF when ICD is not feasible. (Level of Evidence: C)"
Class IIb
"1. EP testing may be considered for risk assessment for SCD in patients with HCM. (Level of Evidence: C) "
"2. Amiodarone may be considered for primary prophylaxis against SCD in patients with HCM who have one or more major risk factor for SCD, if ICD implantation is not feasible. (Level of Evidence: C) "

Sources

References

  1. ↑ 1.0 1.1 1.2 Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS; et al. (2011). "2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. 124 (24): 2761–96. doi:10.1161/CIR.0b013e318223e230. PMID 22068435.
  2. ↑ 2.0 2.1 2.2 Maron BJ (2010). "Contemporary insights and strategies for risk stratification and prevention of sudden death in hypertrophic cardiomyopathy". Circulation. 121 (3): 445–56. doi:10.1161/CIRCULATIONAHA.109.878579. PMID 20100987. Unknown parameter |month= ignored (help)
  3. ↑ 3.0 3.1 Maron BJ, Spirito P, Shen WK; et al. (2007). "Implantable cardioverter-defibrillators and prevention of sudden cardiac death in hypertrophic cardiomyopathy". JAMA. 298 (4): 405–12. doi:10.1001/jama.298.4.405. PMID 17652294. Unknown parameter |month= ignored (help)
  4. ↑ Maron BJ, Shen WK, Link MS; et al. (2000). "Efficacy of implantable cardioverter-defibrillators for the prevention of sudden death in patients with hypertrophic cardiomyopathy". N. Engl. J. Med. 342 (6): 365–73. doi:10.1056/NEJM200002103420601. PMID 10666426. Unknown parameter |month= ignored (help)
  5. ↑ Maron BJ, Spirito P (2008). "Implantable defibrillators and prevention of sudden death in hypertrophic cardiomyopathy". J. Cardiovasc. Electrophysiol. 19 (10): 1118–26. doi:10.1111/j.1540-8167.2008.01147.x. PMID 18384577. Unknown parameter |month= ignored (help)
  6. ↑ Cecchi F, Maron BJ, Epstein SE (1989). "Long-term outcome of patients with hypertrophic cardiomyopathy successfully resuscitated after cardiac arrest". J. Am. Coll. Cardiol. 13 (6): 1283–8. PMID 2703610. Unknown parameter |month= ignored (help)
  7. ↑ Elliott PM, Sharma S, Varnava A, Poloniecki J, Rowland E, McKenna WJ (1999). "Survival after cardiac arrest or sustained ventricular tachycardia in patients with hypertrophic cardiomyopathy". J. Am. Coll. Cardiol. 33 (6): 1596–601. PMID 10334430. Unknown parameter |month= ignored (help)
  8. ↑ Fananapazir L, Chang AC, Epstein SE, McAreavey D (1992). "Prognostic determinants in hypertrophic cardiomyopathy. Prospective evaluation of a therapeutic strategy based on clinical, Holter, hemodynamic, and electrophysiological findings". Circulation. 86 (3): 730–40. PMID 1516184. Unknown parameter |month= ignored (help)
  9. ↑ Bos JM, Maron BJ, Ackerman MJ; et al. (2010). "Role of family history of sudden death in risk stratification and prevention of sudden death with implantable defibrillators in hypertrophic cardiomyopathy". Am. J. Cardiol. 106 (10): 1481–6. doi:10.1016/j.amjcard.2010.06.077. PMID 21059440. Unknown parameter |month= ignored (help)
  10. ↑ Elliott PM, Poloniecki J, Dickie S; et al. (2000). "Sudden death in hypertrophic cardiomyopathy: identification of high risk patients". J. Am. Coll. Cardiol. 36 (7): 2212–8. PMID 11127463. Unknown parameter |month= ignored (help)
  11. ↑ Elliott PM, Gimeno Blanes JR, Mahon NG, Poloniecki JD, McKenna WJ (2001). "Relation between severity of left-ventricular hypertrophy and prognosis in patients with hypertrophic cardiomyopathy". Lancet. 357 (9254): 420–4. doi:10.1016/S0140-6736(00)04005-8. PMID 11273061. Unknown parameter |month= ignored (help)
  12. ↑ Sorajja P, Nishimura RA, Ommen SR, Ackerman MJ, Tajik AJ, Gersh BJ (2006). "Use of echocardiography in patients with hypertrophic cardiomyopathy: clinical implications of massive hypertrophy". J Am Soc Echocardiogr. 19 (6): 788–95. doi:10.1016/j.echo.2006.01.005. PMID 16762758. Unknown parameter |month= ignored (help)
  13. ↑ Spirito P, Bellone P, Harris KM, Bernabo P, Bruzzi P, Maron BJ (2000). "Magnitude of left ventricular hypertrophy and risk of sudden death in hypertrophic cardiomyopathy". N. Engl. J. Med. 342 (24): 1778–85. doi:10.1056/NEJM200006153422403. PMID 10853000. Unknown parameter |month= ignored (help)
  14. ↑ Spirito P, Autore C, Rapezzi C; et al. (2009). "Syncope and risk of sudden death in hypertrophic cardiomyopathy". Circulation. 119 (13): 1703–10. doi:10.1161/CIRCULATIONAHA.108.798314. PMID 19307481. Unknown parameter |month= ignored (help)
  15. ↑ Monserrat L, Elliott PM, Gimeno JR, Sharma S, Penas-Lado M, McKenna WJ (2003). "Non-sustained ventricular tachycardia in hypertrophic cardiomyopathy: an independent marker of sudden death risk in young patients". J. Am. Coll. Cardiol. 42 (5): 873–9. PMID 12957435. Unknown parameter |month= ignored (help)
  16. ↑ 16.0 16.1 Olivotto I, Maron BJ, Montereggi A, Mazzuoli F, Dolara A, Cecchi F (1999). "Prognostic value of systemic blood pressure response during exercise in a community-based patient population with hypertrophic cardiomyopathy". J. Am. Coll. Cardiol. 33 (7): 2044–51. PMID 10362212. Unknown parameter |month= ignored (help)
  17. ↑ 17.0 17.1 Sadoul N, Prasad K, Elliott PM, Bannerjee S, Frenneaux MP, McKenna WJ (1997). "Prospective prognostic assessment of blood pressure response during exercise in patients with hypertrophic cardiomyopathy". Circulation. 96 (9): 2987–91. PMID 9386166. Unknown parameter |month= ignored (help)
  18. ↑ 18.0 18.1 Maki S, Ikeda H, Muro A; et al. (1998). "Predictors of sudden cardiac death in hypertrophic cardiomyopathy". Am. J. Cardiol. 82 (6): 774–8. PMID 9761089. Unknown parameter |month= ignored (help)
  19. ↑ 19.0 19.1 19.2 Boriani G, Maron BJ, Shen WK, Spirito P (2004). "Prevention of sudden death in hypertrophic cardiomyopathy: but which defibrillator for which patient?". Circulation. 110 (15): e438–42. doi:10.1161/01.CIR.0000144463.65977.C9. PMID 15477422. Unknown parameter |month= ignored (help)
  20. ↑ Hauser RG, Maron BJ, Marine JE; et al. (2008). "Safety and efficacy of transvenous high-voltage implantable cardioverter-defibrillator leads in high-risk hypertrophic cardiomyopathy patients". Heart Rhythm. 5 (11): 1517–22. doi:10.1016/j.hrthm.2008.08.021. PMID 18984525. Unknown parameter |month= ignored (help)
  21. ↑ Kleemann T, Becker T, Doenges K; et al. (2007). "Annual rate of transvenous defibrillation lead defects in implantable cardioverter-defibrillators over a period of >10 years". Circulation. 115 (19): 2474–80. doi:10.1161/CIRCULATIONAHA.106.663807. PMID 17470696. Unknown parameter |month= ignored (help)
  22. ↑ Maisel WH, Sweeney MO, Stevenson WG, Ellison KE, Epstein LM (2001). "Recalls and safety alerts involving pacemakers and implantable cardioverter-defibrillator generators". JAMA. 286 (7): 793–9. PMID 11497532. Unknown parameter |month= ignored (help)
  23. ↑ Maron BJ, Nishimura RA, McKenna WJ, Rakowski H, Josephson ME, Kieval RS (1999). "Assessment of permanent dual-chamber pacing as a treatment for drug-refractory symptomatic patients with obstructive hypertrophic cardiomyopathy. A randomized, double-blind, crossover study (M-PATHY)". Circulation. 99 (22): 2927–33. PMID 10359738. Unknown parameter |month= ignored (help)
  24. ↑ Nishimura RA, Trusty JM, Hayes DL; et al. (1997). "Dual-chamber pacing for hypertrophic cardiomyopathy: a randomized, double-blind, crossover trial". J. Am. Coll. Cardiol. 29 (2): 435–41. PMID 9015001. Unknown parameter |month= ignored (help)
  25. ↑ Kappenberger L, Linde C, Daubert C; et al. (1997). "Pacing in hypertrophic obstructive cardiomyopathy. A randomized crossover study. PIC Study Group". Eur. Heart J. 18 (8): 1249–56. PMID 9458416. Unknown parameter |month= ignored (help)
  26. ↑ Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M; et al. (2006). "ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". Circulation. 114 (10): e385–484. doi:10.1161/CIRCULATIONAHA.106.178233. PMID 16935995.
  27. ↑ Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM III, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices). Circulation. 2008; 117: 2820–2840. PMID 18483207
  28. ↑ Vardas PE, Auricchio A, Blanc JJ, Daubert JC, Drexler H, Ector H; et al. (2007). "Guidelines for cardiac pacing and cardiac resynchronization therapy. The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in collaboration with the European Heart Rhythm Association". Europace. 9 (10): 959–98. doi:10.1093/europace/eum189. PMID 17726043.
  29. ↑ Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW (2011). "2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Journal of the American College of Cardiology. 58 (25): 2703–38. doi:10.1016/j.jacc.2011.10.825. PMID 22075468. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  30. ↑ Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW (2011). "2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Journal of the American College of Cardiology. 58 (25): e212–60. doi:10.1016/j.jacc.2011.06.011. PMID 22075469. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)


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