© 2000 by European Society of Cardiology
Copyright © 2000, European Society of Cardiology
Paced ventricular electrogram fractionation and sudden death in hypertrophic cardiomyopathy and other non-coronary heart diseases
Departments of Medicine and Biochemistry, University of Cambridge and Papworth Hospital, Cambridge, UK
* Corresponding author. Tel.: +44-1480-830-541, ext. 4189; fax: +44-1480-831-819
Received 27 September 1999; accepted 21 March 2000
KEYWORDS Arrhythmia (mechanisms); Cardiomyopathy; Sudden death; Ventricular arrhythmias
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1 Introduction |
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The prediction of sudden arrhythmic death (SCD) in patients with non-coronary heart disease has become increasingly important because of the need to select high risk patients who require prophylactic implantable cardioverter-defibrillators (ICD). Hypertrophic cardiomyopathy (HCM) is an important cause of SCD, and while it is clear that ICDs are effective in aborting SCD due to ventricular fibrillation [1–3], there is no generally accepted method of risk stratification to allow large-scale, selective ICD implantation in such patients [4]. This article reviews the various trials which have been performed to predict SCD in patients with HCM. Then an emerging technique which was initially developed for HCM, paced electrogram fractionation analysis (PEFA), is reviewed. This technique is based on detection of the substrate for VF and has promise in identifying high risk patients with HCM and other non-coronary heart diseases which cause SCD. Finally, preliminary results obtained in man and animal
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2 Statistical problems in designing HCM trials |
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3 Classification of EP methods for prediction of SCD in HCM |
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4 Tests involving detection of an arrhythmogenic substrate |
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5 Detection of a trigger for VF |
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6 Changes in autonomic activity |
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7 Development of paced electrogram fractionation analysis |
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8 Clinical technique |
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9 Analysis of electrograms |
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10 Analysis of conduction curves |
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11 Application in other diseases which cause VF |
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12 Comparison of the technique with surface ECG methods of SCD prediction |
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13 Problems and limitations of the clinical technique |
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14 Fractionation in the isolated animal heart |
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15 Conclusion |
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